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GO Team Application - Alaska 2023
Applications due
Monday, January 9, 2023
Application Process:
1. Read the Trip FAQ sheet
HERE
.
2. Complete the application (below)
3. If all of this is completed on time, the trip leader will contact you within 4-6 weeks of the application deadline to let you know whether you have been selected.
All information on this form will be kept confidential, with disclosure related only to trip placement (Impact staff, Trip Leaders, Medical and Legal advisers, etc.) or as required by law.
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First Name
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Last Name
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Email Address
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Phone Number
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Address Line 1
Address Line 2
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City
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State/Province/Region
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Zip/Postal Code
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Preferred method of contact:
-- Select --
Email
Phone
*
Date of Birth:
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Gender:
-- Select --
Female
Male
Undecided
*
Current Grade in School (2022-23):
-- Select --
6th
7th
8th
9th
10th
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School Name and School District you attend:
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Please indicate your country of citizenship:
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What is your full legal name (including middle name) as it would appear on an airline ticket:
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Trip ID:
-- Select --
AK0723
Parent (or legal guardian) info
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Parent # 1 Name:
*
Parent #1 Email:
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Parent #1 Phone:
Parent #1 secondary phone:
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Parent #1 Relationship to student:
Parent #2 Name:
Parent #2 Email:
Parent #2 Phone:
Parent #2 secondary phone:
Parent #2 relationship to student:
Your Participation in the Trip
Team Meetings
Below are the dates for the Go Team meetings. Please indicate whether you can attend each meeting. Attendance at these meetings is expected by all team members.
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Sunday, February 19 from 3:00 - 5:45pm (Parents & Students for first 30-60 minutes, students only for remainder of meeting):
Yes
No
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Sunday, March 12 from 3:30-6:00pm:
Yes
No
*
Sunday, April 16 from 3:00-5:30pm:
Yes
No
*
Team overnight June 3 (morning)- June 4 (afternoon) - Location TBD:
Yes
No
*
Thursday, June 22 - Final Preparations Meeting (time TBD):
Yes
No
*
Sunday, July 23 - Celebration Trip Presentation (time & date subject to confirmation):
Yes
No
Your Interest in the Team
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If there are any obstacles that might keep you from going on this trip or attending any of the team meetings, please explain them below.
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What are some things you have heard about the Alaska GO Team trip that have made you excited to apply for the team?
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There are many cool and exciting aspects of visiting Alaska, but the primary purpose of this trip is to serve others. Why do you desire to be a part of a team with this purpose?
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Support raising is a required aspect of going on a GO Team trip. Support raising is beneficial for team members as it teaches them the importance of relying on God and fellow believers for financial, prayer, and emotional support. Where do you anticipate the funds for this trip to come from?
Spiritual Info
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Are you are regular attender of Blackhawk Church?:
Yes
No
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Which site do you typically attend?:
-- Select --
Brader Way
Downtown
Fitchburg
Online
I do not attend Blackhawk Church
How long have you been attending Blackhawk Church?:
If you attend another church, indicate the name:
*
Where did you first learn about Jesus Christ? What are you currently doing to help you learn more about Jesus or to connect with him?
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Briefly describe your personal beliefs about Jesus
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Are you involved in MSM Community Groups?:
Yes
No
If so, what Community Group are you a part of?:
-- Select --
Fitchburg/W Madison Girls
Fitchburg/W Madison Boys
Verona Boys
Verona Girls
Brader Way Site Girls
Brader Way Site Boys
Waunakee
Mount Horeb
If no, why not?:
If so, who are your middle school leaders and/or 4:1 leader?:
Ministry Experience
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In what areas of the church are you currently serving or have you served recently?:
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Please describe what ministry experience you have had with adults and/or children (examples are things like working in the nursery, visiting nursing homes, etc.)
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Please describe any previous or current experience that you have working/volunteering in community service
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Have you ever been on a mission trip before?:
Yes
No
If yes, may we contact the trip leader?:
Yes
No
Leaders Name & Contact info:
If you have been on a mission trip before, please describe your experience. What did you do?
Background info
Information will be kept confidential, with disclosure only related to ministry services, or as required by law.
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Do you have any medical conditions (e.g. diabetes, lactose intolerance, asthma, history of heart attack or stroke, etc.)? If so, please indicate here:
*
Do you currently have or have you had in the past any mental health issues (depression, bipolar disorder, generalized anxiety disorder, history of psychiatric treatment or hospitalization, etc.). If so, please indicate here:
*
Do you have any physical limitations or conditions that will prevent you from performing certain types of activities? If so, please indicate here:
COVID
*
Blackhawk’s official current policy (as of November 2022) is that COVID vaccination and mitigation strategies (masking, social distancing, etc.) will not be required for GO Team participants unless required by our partner, transportation providers (airline, bus, etc.), or local government. (As of November 2022, Eaglecrest does not require COVID vaccinations or mitigations. Blackhawk will continue to monitor the COVID situation and policies, and will communicate any changes as necessary.)
I understand and agree with this policy
I'd like to talk to someone about this
*
In the event of a
student participant
contracting COVID while on the trip, that participant may need to be quarantined for a duration past the scheduled end of the trip. Quarantining would happen at Eaglecrest until the participant is cleared to travel. A minimum of two leaders would stay behind with the student, per Student Ministry policy.
I understand and agree to this policy
I'd like to talk to someone about this
References
References are required for consideration for this trip and to meet our Child Protection Policy standards. Please provide complete mailing addresses and email address for three references that have acquired accurate knowledge of your character and meet the following criteria:
known you for more than one year
at least 18 years old
not related to you
not your significant other (e.g., boy/girlfriend, spouse)
not a Blackhawk staff member
if possible, have witnessed you interacting with children.
***If you are actively involved with MSM, it is required that you list one of your MSM or 4:1 leader as a reference.
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Reference #1 Name:
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Reference #1 Relationship:
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Reference #1 Email:
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Reference #1 Address:
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Reference #2 Name:
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Reference #2 Relationship:
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Reference #2 Email:
*
Reference #2 Address:
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Reference #3 Name:
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Reference #3 Relationship:
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Reference #3 Email:
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Reference #3 Address:
By signing below I agree that the information provided in this application is true, and I authorize the Church (Blackhawk Evangelical Free Church and/or its representative) to verify the information on this form. I authorize any organizations, institutions, churches or references listed in this application to give the church any information (including opinions) that they may have regarding my character and suitability for participation in this trip. I hereby release any individual, organization, employer, church or reference from any and all liability for any damages that may at any time result to me, my heirs, or family, on account of compliance or any attempt to comply with this authorization. Should my application be accepted I agree to adhere to all policies of Blackhawk Church.
*
Signature (Typing your name here serves as your signature):
Parental consent
Please have a parent or legal guardian fill out this section.
*
Do you support your student serving on this trip?:
Yes
No
*
Is there anything else that you would like us to know that would help improve your child's experience on the trip? (i.e. child's personality, fears, likes/dislikes, etc.)
*
Parent/Guardian Signature (Typing your name here serves as your signature):
Submit Form