New York City Missions Trip

Parent/Guardian Name

Parent/Guardian #2 Name

Parent/Guardian #1 Phone

Parent/Guardian #2 Phone

This address will receive a confirmation email

Student Name

T-Shirt Size

Address

Deposit to hold your place.

Name of Emergency Contact (Not a Parent or Guardian)

Emergency Contact Phone

List any current allergies, illnesses, physical conditions or medications:

Have you filled out a Hope Church Consent Form at https://forms.hopebrunswick.org ?

Yes No

Is Trip Sponsor (Ignite) authorized to approve medical treatment?

Yes No

Is participant covered by personal/family medical insurance?

Yes No

Participant Agreement (To be completed by Participant or by Parents, if Participant is a minor)

I acknowledge that participation in the above trip involves risk to the individual listed above as the Participant (referred to as “Participant” throughout this document) (and to Participant’s Parent, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the above trip, the Participant (or Parent acknowledges and accepts the risks of injury associated with participation in the trip. The Participant (or Parent) accepts personal financial responsibility for any injury or other loss sustained during the trip or during transportation to and from the trip, as well as for any medical treatment rendered to the Participant that is authorized by the Trip Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Trip Sponsor”). Further, the Participant (or Parent) releases and promises to indemnify, defend, and hold harmless the Trip Sponsor and its agents, employees, volunteers, or any other representatives for any injury related directly or indirectly out of the above trip, whether such injury arises out of the negligence of the Trip Sponsor or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or Parent) agrees to resolve the matter through a mutually acceptable Biblically based alternative dispute resolution process. If the Participant (or Parent) and the Trip Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association. By signing below I acknowledge and warrant that the information that I have provided on this form is true and correct to the best of my knowledge. I further agree to immediately notify the Activity Sponsor of any change in the information presented. I understand that this form is valid and legally binding until revoked in writing by the Participant (or the Participant’s parent(s) or guardian(s) if the Participant is a minor).

Photo Use Agreement

I agree to: 1. Use and storage of Participant’s image, by means of digital or film photography, video photography, audio recording or other documentation, with respect to the trip. 2. Use of any stored data including Participant’s image in printed publications of Trip Sponsor (Hope Church). 3. Use of any stored data including Participant’s image in electronic publications of Trip Sponsor. 4. Use of any stored data including Participant’s image in any Web site created by or for Trip Sponsor for its sole benefit. 5. If I am signing this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to sign this agreement on behalf of the child.

Yes No

By signing below I acknowledge and warrant that the information that I have provided on this form is true and correct to the best of my knowledge. I further agree to immediately notify the Activity Sponsor of any change in the information presented. I understand that this form is valid and legally binding until revoked in writing by the

Participant (or the Participant’s parent(s) or guardian(s) if the Participant is a minor).

Electronic Signature of Parent/Guardian if participant is a minor

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

July 11-19

Who: Completed 8-12 Grades in Summer 2020

What: Students can expect to get to have a life changing week as they serve, learn, and grow together in the setting of New York City and Union City, New Jersey. We will be running a Day Camp, a community outreach, feeding the homeless, helping teach ESL, and learning about missions/church Planting. They will also be able to take in some of the sights of New York City including the grounds of 9/11, Central Park, and Time Square.

Where: Union City, New Jersey and New York City.

When: July 11-18

Why: God cares for the people we will be serving, many who have never heard the Gospel, our prayer and desire is for our students to feel and understand God’s call on their lives.

Cost: Approximate $630- $730 depending on the number of students and leaders that attend.

Requirements for Students: $100 deposit due at sign up, scripture memorization with the group, pass test of memorized scripture, Mission Trip meetings and training meetings.

Informational Meeting for Parents and Students: November 10th, between service 10:15-11am.

Group Size Limit: 15 Students 5 Leaders

Requirements for Parents: Attend Parent Meetings, first one Nov 10th – between services – 10:15-11am.

Fundraising Opportunities: Flapjacks at Applebees, Hope’s Got Talent – Mar 13, Stoller’s Pastries for Easter, student written letters for support. Students are required to help, if your student cannot help/participate, a parent can fill in, if neither student/parent participates they will not receive the funds.

What portion of the cost is the student responsible for? $100 deposit and remaining balance of the funds not raised by fundraisers.Please fill out this form and click submit.

New York City Missions Trip

Description

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