127 Worldwide Mission Project Application

Mission Project Application

Trip Application for 127 Worldwide Mission Project

I have served on a 127 Worldwide mission project within the last 5 years*
I have a 127 Worldwide Managed Missions Account?*
Preferred Mission Project:*
Name*
Prefix First Last
Preferred First Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Gender*
Birth Date*
T-shirt Size
All t-shirts are unisex sizes.
Passport Information
Do you have a passport?*
*Your passport must be valid for 6 months beyond your project date.
Name On Passport
Passport Number
Date Issued
Expiration Date
Passport Issuing Country
Nationality
Emergency Contact Information
Name*
First Last
Relationship
Phone*
Email
Health Concerns and/or Medications
References
Please provide the following information for 3 individuals willing to serve as a reference on your behalf. 127 Worldwide will email a reference form link to the email addresses you provide.
Reference 1 Name*
First Last
Reference 1 Email*
Reference 2 Name*
First Last
Reference 2 Email*
Reference 3 Name*
First Last
Reference 3 Email*
Conditions of Volunteer Participation and Release from Liability
127 Worldwide’s desire is to build a community of empowered volunteers dedicated to developing into servant leaders both physically and spiritually. As a volunteer, I will cooperate in the fulfillment of 127 Worldwide’s mission. Minors under the age of 16 who plan to travel without a parent or guardian must seek approval from 127 Worldwide staff.
Background Certification: I certify that all of the information provided on this application is true and complete. I authorize the 127 Worldwide staff to investigate and verify any and all of the information I have submitted. Because 127 Worldwide strives to provide a safe environment for children and youth, I understand that 127 Worldwide may order a criminal history check, and I authorize this investigation. Volunteer Terms: I agree to abide by 127 Worldwide policies, procedures, and Code of Conduct. I understand 127 Worldwide does not provide any health benefits (i.e. medical, dental, workers compensation, etc.) however limited travel insurance may be provided for me as a volunteer; I understand it is my responsibility to provide this coverage. I understand that 127 Worldwide does not provide volunteer compensation or trade volunteer services for paid mission trips. Property Loss: I understand 127 Worldwide is not responsible for my personal property loss, damaged or stolen while participating in 127 Worldwide volunteer activities. Medical Treatment: I give permission for 127 Worldwide representatives to provide or arrange for emergency care for me, and to arrange for transport to an emergency center for treatment. I consent to medical treatment deemed immediately necessary or advisable by a physician if I am unable to act on my own behalf. I further understand that 127 Worldwide is not responsible for payment for such medical treatment. Photography or Digital Image Permission: I give permission for 127 Worldwide to use, without limitation or obligation, photographs or other media that may include my image or voice to promote or interpret 127 Worldwide programs. Release from Liability: I understand that accidents may occur during my volunteer activities. By signing below, I release the 127 Worldwide, its agents, directors, consultants, and employees from all liability based on any damage, loss, or injury, whether it is the result of ordinary negligence or otherwise, caused to me or my dependent from participation as a volunteer. Consent for Reference Release: I give permission to any person, I provide as a reference to disclose in good faith any information they may have regarding my qualifications to serve on a 127 Worldwide mission project. I will not hold 127 Worldwide and any persons giving references, liable for the exchange of this information. I also waive the right to see references prior to submission to 127 Worldwide. Financial Policies: 127 Worldwide reserves the right to distribute funds in a way that best fulfills the overall goal of the team, meets the needs of the individual team members, and exhibits good stewardship. All monies received for specific trips will be allocated as deemed appropriate by 127 Worldwide. These monies cannot be managed by a volunteer or donor once received. All support raised is designated for a specific trip, not to an individual person. Additionally, any extra money that a team member raises goes to other trip expenses or at the discretion of 127 Worldwide.
Acknowledgement and Agreement of Terms*
- I agree to the terms and conditions listed above
Mission Project Participant Signature*
Date*
Alumni or Special Application

Mission Project Application

Passport Information

Emergency Contact Information

References

Conditions of Volunteer Participation and Release from Liability

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