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GO Team Application - Alaska 2019
Applications due by Monday, January 7, 2019
Application Process:
1. Read the Trip FAQ sheet
here
and select "Global/National" to find the applicable trip
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 accepted.
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
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Date of Birth:
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Gender:
-- Select --
Female
Male
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Current Grade in School (2017-18):
-- Select --
Sixth
Seventh
Eighth
Ninth
Tenth
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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# (see FAQ sheet):
Parent info
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Parent # 1 Name:
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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 interest in the Trip
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 10 from 3:00 - 5:45pm (Parents & Students for first 30-60 minutes, students only for remainder of meeting):
-- Select --
Yes
No
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Sunday, March 10 from 3:30-6:00pm:
-- Select --
Yes
No
*
Sunday, April 14 from 3:00-5:30pm:
-- Select --
Yes
No
*
Team overnight June 1 (morning)- June 2 (afternoon) - Location TBD:
-- Select --
Yes
No
*
Thursday, June 20 - Final Preparations Meeting (time TBD):
-- Select --
Yes
No
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Sunday, July 14 - Show & Tell (time & date subject to confirmation):
-- Select --
Yes
No
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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?:
-- Select --
Yes
No
Which site do you typically attend?:
-- Select --
Brader Way
Downtown
Fitchburg
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 Home Groups?:
-- Select --
Yes
No
If yes, please select your Home Group:
-- Select --
Fitchburg Girls
Fitchburg Boys
Middleton East/Kromrey Girls
Middleton East/Kromrey Boys
Middleton West/Glacier Creek Girls
Middleton West/Glacier Creek Boys
Mt. Horeb Girls
Mt. Horeb Boys
Oregon Boys
Oregon Girls
Verona Girls
Verona Boys
Waunakee Girls
Waunakee Boys
West Madison Girls
West Madison Boys
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?:
-- Select --
Yes
No
If yes, may we contact the trip leader?:
-- Select --
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.
*
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:
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:
*
Reference #3 Relationship:
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Reference #3 Email:
*
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.
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Signature:
Parental consent
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Do you support your student serving on this trip?:
Yes
No
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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