JA-29 Mt Zion UMC July 11-18, 2020              CSI Ministries Team Member Application
Please complete every field of this application. For questions that do not pertain to you, write "N/A" in the space provided.

You are encouraged to fill out your application as soon as possible, but are required to have it submitted no later than 45 days prior to your trip. We greatly appreciate your cooperation.

***BY ADDING YOUR ELECTRONIC SIGNATURE TO THIS APPLICATION YOU ARE AGREEING WITH THE TEAM MEMBER AGREEMENT, GENERAL RELEASE, CONSENT AND WAIVER FORM. YOUR AGREEMENT TO THE CONSENT FORM AT THE BOTTOM OF THIS APPLICATION IS REQUIRED TO TRAVEL WITH CSI MINISTRIES.***
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First Name (if international as it appears on passport): *
Middle Name (if international as it appears on passport): *
Last Name (if international as it appears on passport): *
Street Address *
City *
State *
Zip Code *
Cell Phone *
Please write as 123-456-7890
Home Phone
Please write as 123-456-7890
E-mail Address *
CSI Ministries may send me news letters, information and donation request by e-mail. *
Required
Emergency Contact Information *
Person not traveling with you (include phone number, e-mail and mailing address)
Employer *
If retired, previous occupation
Occupation *
Date of Birth *
mm/dd/yyyy
Passport Number (international trips) *
Submit copy of passport photo with consent form
Passport Expiration Date (international trips) *
Gender *
Required
T-Shirt Size - Men's Shirts *
Have you been convicted of a felony? *
Required
If you have been convicted of a felony, please explain in the space provided *
Marital Status *
Required
Name of spouse if married *
Name of your Church and Address *
Include pastor's name and phone number
What sparked your interest in a mission trip? *
What skills or expertise do you have? *
List foreign languages you speak *
Is this your first trip with CSI Ministries? *
Required
Physician Information *
Please list physician's name, phone number and address
Are you currently under a physicians care? *
Required
If you are under a physicians care, please explain in the space provided. *
List all medical conditions that may have an impact on this trip *
If you have allergies, please list type and medications used to control *
If you have any physical restrictions please explain all in the space provided *
Example: Cannot lift more than 50 lbs
Please list all current medications *
Include dosage, frequency and type (Example: Y Mediaction 50mg 2X daily pill/liquid)
Date of last tetanus shot (Must be within last 10 years) *
Note: Other immunizations may be required based on destination
Please list any special dietary requirements *
We believe the bible to be the inspired, the only infallible, authoritative Word of God. We believe there is only one God, eternally existent in three persons - Father, Son and Holy Spirit. We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory. We believe that for the salvation of lost sinful man, regeneration by the Holy Spirit is absolutely essential. We believe in the present ministry of the Holy Spirit by who’s indwelling the Christian is enabled to live a godly life. We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life, and they that are lost unto the resurrection of damnation. We believe that the Church is the body of Christ, that all who are united by faith to Christ are members of the same, and that, having thus become members one of another, it is our solemn and covenant duty to fellowship with one another in peace, and to love one another with pure and fervent hearts. *
Required
All applications are due 45 days prior to departure *
Required
TEAM MEMBER AGREEMENT, GENERAL RELEASE, CONSENT AND WAIVER                    Throughout this document CSI Ministries, Inc. is herein often referred to as “CSI” or “CSI Ministries”. To ensure that my mission trip is a good experience for the team and those we serve, I agree to dress in a manner that will not call undue attention to myself. I understand this is for my safety as well as cultural sensitivity. If I am a female, I will ware no tight-fitting tank tops or spaghetti strap shirts or dresses, no mini-skirts or short-shorts. If I am a male, I will wear a shirt at all times (except at swimming locations). I understand that my Team Leader and/or the mission Field Director may ask me to change my attire should they feel I am inappropriately dressed for the setting in which I am serving. Cultural acceptance regarding body piercings and tattoos, as well as some clothing items, varies from field to field so please contact CSI for more information on what is and is not acceptable in the country in which you will serve. I agree that I will not use my cell phone, personal music players, personal computing devices, or personal electronic devices while on the field, except when traveling or blogging, so I will not be distracted, or distract another, from experiencing all that God has in store for the team ministry. I agree not to bring any or possess or use tobacco, alcoholic beverages, controlled substances or drugs, other than those prescribed by my doctor, while on a CSI ministry team. In consideration of participating in a short-term mission trip with CSI, I agree to participate as a team member and to accept leadership from those designated, and to be flexible as conditions change. I agree that I may be subject to discipline for failure to comply with my obligation herein, including but not limited to, being sent home at my own expense. I further acknowledge that CSI is an Evangelical Christian Organization that believes that the Bible is the inspired Word of God. I represent to CSI that I have no physical, mental, or emotional conditions that would put either others or myself at risk, and I agree to authorize the release of any medical, psychological or other information to CSI if requested. I understand that as a volunteer, Worker’s Compensation or any other employer type of insurance does not cover me. I consent to the medical and dental treatment by CSI, or such others that it may designate, in the event that I am in need of such treatment and I am unable to consent to it because of physical, mental, or other incapacity. If third parties other than CSI provide treatment, and there is a charge therefore, I agree to pay the charges and hold CSI harmless there from.I understand that as a CSI team member, I may be traveling to and from, and living and working in areas that are dangerous, both in the United States and foreign countries.  Particularly, and without limiting the above acknowledgement, I understand that if I travel outside the United States: 1.) Medical and dental service may be inadequate or totally lacking; 2.) I may be exposed to illnesses and diseases’; 3.) Law enforcement may be inadequate or totally lacking; 4.) Motor vehicle travel may be dangerous and motor vehicle laws may not be observed nor enforced; 5.) Food and water may be unsanitary, unsafe, and dangerous; 6.) There may be social unrest, terrorism, insurrection, revolution or war. I further understand that the above listing of dangers is meant to be illustrative only, that many other dangers exist, and that I may be exposed to them in one form or another. With full knowledge of the above, I have decided to expressly assume the risk and volunteer with CSI. I am aware that pictures of myself (or of my child if participant is under age 18) may be taken while on a CSI Ministries missions experience. I am aware that the pictures may be posted to a website, shared electronically, or used to create a video or brochure to highlight and/or promote the activities of CSI Ministries. Pictures posted electronically or shared with CSI are considered the property of CSI Ministries, Inc. and I give CSI Ministries, Inc. the express permission to use these images in any way that best promotes the ministries of CSI. I understand that CSI will not sell the rights to these images. I also understand that CSI may share my personal contact information (provided on an application) with its ministry partners. In consideration of volunteering with CSI on a short-term mission trip, and with the intention of binding myself, my heirs, successors and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE CSI Ministries, Inc., its officers, directors, employees, volunteers, agents, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my service as a team member with CSI, whether or not due to the negligence, strict liability, or any other breach or fault. This includes, but is expressly not limited to death, bodily injury, personal injury, property damage, loss or theft of property, economic loss or any other damage, loss or cost. This document shall be construed according to the laws of the State of Indiana. I acknowledge that I have carefully read this Team Member Agreement, General Release, Consent and Waiver, I know and understand that the contents thereof, that this document was freely and voluntarily executed and that I was given the opportunity to seek independent legal counsel on any and all matters herein before signing it. I also understand that CSI reserves the right to decline any applicant for any reason that is not in the best interest of CSI. Final payment is due 30 days prior to departure; At this point all fees paid to CSI Ministries, Inc, become NON-REFUNDABLE and NON-TRANSFERABLE.   *
Required
Electronic Signature
Signature of Parent or Guardian if team member is under 18 years of age.
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