GO Team Application - Ohio 2019

Applications due by Thursday, February 21, 2019

Application Process:

1. Read the Trip FAQ sheet here and select "Global/National" to find the applicable trip
2. Complete Part 1 of the application (below)
3. If you are over age 18, complete Part 2 of the application, which is a background check. Info will be provided to you after you submit this form via email.
4. 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 accepted. Please know that space on this trip is limited - applying does not guarantee that you will be accepted for this trip.

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.

*Address Line 1
Address Line 2
*Zip/Postal Code
*Preferred method of contact:
*Date of Birth:
*What school do you attend?:
*Current Grade in School:
*What is your full legal name as it would appear on an airline ticket?:
*T-Shirt Size:
*Trip ID# (see FAQ sheet):

Parent Info

If you are under age 18, please complete this section. If you are over age 18, please skip this section.
Parent #1 Name:
Parent #1 Email:
Parent #1 Phone:
Parent #1 Secondary Phone:
Parent #1 Relationship to You:
Parent #2 Name:
Parent #2 Email:
Parent #2 Phone:
Parent #2 Secondary Phone:
Parent #2 Relationship to You:

Your Interest in the Trip

Below are the dates for the GO Team meetings. Please indicate whether you can attend each meeting.
*Sunday, March 10th, 2019 from 2:30-4:30pm (with parents & students for first hour, students only for second hour)
*Wednesday, June 12, 2019 from 6pm-9pm (Team Day/Tool Training)
*Sunday, July 28, 2019 at 11:00am (Show & Tell)
*If there are any obstacles that might keep you from going on this trip/attending any team meetings, please explain:
*Please explain your primary reasons for applying for and desiring to be a part of this GO Team trip.:
*Support raising is a required aspect of going on a GO Team trip. Where do you anticipate the funds for this trip to come from? :

Skills Survey

How comfortable are you with performing the following tasks?

*These questions have been provided by Next Step Ministries and will be used to help create work assignments. 
*Using a Hammer:
*Using a Tape Measure:
*Using a Ladder:
*Using a Power Drill:
*Drywall/Sheetrock Work:
*Flooring (tile/laminate):
*Stairs or Ramps:
*Foundation Work:

Spiritual Info

*Are you are regular attender of Blackhawk Church or High School Ministry?:
Which site do you typically attend?:
*How long have you been attending Blackhawk Church?:
Are you a regular attender of another church? If so, please indicate::
*How did you find out about this trip?:

Ministry Experience

*Have you been on a mission trip before?:
If yes, may we contact the trip leader?:
Leader's Name & Contact Info::
If you have been on a mission trip before or been involved in community service,please describe your previous experience. What did you do? 

Background Info

Information will be kept confidential, with disclosure only related to ministry services, or as required by law.

Health Background

Do you have any medical conditions (e.g. diabetes, lactose intolerance, asthma, history of heart attack or stroke, etc.)?:
*Please indicate, if applicable:
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.)?:
*Please indicate, if applicable:
Do you have any physical limitations or conditions that will prevent you from performing certain types of activities?:
*Please indicate, if applicable:
Do you have a drug, alcohol and/or anger problem? Does anyone who knows you think that you have a drug, alcohol and/or anger problem?:
*Please indicate, if applicable:
Are there any past or present issues (spiritual, physical, emotional/mental, social), which would hinder your ability to work appropriately with children?:
*Please indicate, if applicable:
Have you in the past or are you currently struggling with any addictions (alcohol, drug, pornography, etc.)?:
*Please indicate, if applicable:
Have you ever been accused, charged, or convicted of a criminal offense (felony or misdemeanor) other than a parking violation?:
*Please indicate, if applicable:


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.

***It is required that one of your references either be your HSM home group leader or a mentor to you.
*Reference #1 Name:
*Reference #1 Relationship:
*Reference #1 Email:
*Reference #1 Address:
*Reference #2 Name:
*Reference #2 Relationship:
*Reference #2 Email:
*Reference #2 Address:
*Reference #3 Name:
*Reference #3 Relationship:
*Reference #3 Email:
*Reference #3 Address:
*Blackhawk completes background checks upon the start of service, and then every three years for continued service. In the time between background checks, I understand that I am required to self-report any misdemeanor charges/convictions, felony charges/convictions or alcohol- or drug-related citations I receive during the season I am in service to Blackhawk.
Upon submitting this form, you will receive an email about providing background check information. IF YOU ARE 18 YEARS OR OLDER, YOUR APPLICATION WILL NOT BE CONSIDERED COMPLETE UNTIL YOU HAVE SUBMITTED YOUR BACKGROUND CHECK via the instructions you will receive via an email.

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.

In the interest of safety and security I, the undersigned applicant, authorize Blackhawk Evangelical Free Church to procure background information about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request. Also, I understand that I may receive a written summary of my rights under the Fair Credit Reporting Act. :


If applicant is 17 years old or younger, please have a parent or legal guardian fill out this section.
Do you support your student serving on this trip?:
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):