Mailing Address: Work Phone: City, State, Zip: Cell Phone: Age: Sex: address:

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1 WILLIAMSPORT DISTRICT SUSQUEHANNA CONFERENCE UNITED METHODIST CHURCH VOLUNTEERS IN MISSION Team Member Application The mission trip team leader will not share this information except as required and related to the mission trip (e.g. to treat a medical condition). NAME & LOCATION of PROJECT: MARCH 2015 MISSION JOURNEY TO SWANQUARTER, NC DATE: MARCH 22 28, 2015 COST: *$250 (Payable to Williamsport District SUSUMC, with SWANQUARTER, NC VIM TRIP noted) Name: Home Phone Mailing Address: Work Phone: City, State, Zip: Cell Phone: Age: Sex: address: Occupation: Hobbies/interests: Name of Church: Church Address: Pastor: Pastor's Phone: Do you have a Crew Cab PU, Van or Mini Van that you would be willing to use on this trip? Yes No T-shirt Size *Above individual registration cost includes gas for vehicle transportation throughout the trip, housing, and meals from Sunday evening through Friday. Registration fee does NOT include meals, snacks and drinks on the trips to and from the Mission destination. 1. Please indicate the state of your physical and emotional health (the trip will include rigorous activity and long hours). Do you have any allergies, special diet requirements, etc.? 2. Team members may be asked during a church service to give a 2-3 minute testimonial. Would you be comfortable doing this? 3. Please circle all applicable skills below and explain in detail where appropriate. Previous Missions experience & location: Building/carpentry/masonry/electrical/plumbing skills: Fair Good Excellent Professional Other Health Care: Physician Nurse Dentist First Aid training CPR training; Other: Working with Youth: recreation storytelling art singing crafts: Other : Music / Singing skills: solo small groups total group only;

2 Instruments: Giving post-trip talks and slide presentations (elaborate) 4. Would you be interested in performing one or more of the following functions for the VIM team on this trip? Spiritual leader (manage daily devotions, leading in prayer, related skills): Project Leader (Usually have 3 project sites; each with two project leaders): Project Material Expeditor (Work with project leaders to obtain supplies in timely manner.) Manage Team Photography (collect photos from and prepare CD/DVD for all team members) Assist team leader with daily trip journal Advance team member: (One vehicle load to deploy early, purchase food, visit assigned projects, and notify team of any special tool and material requirements) I understand that team members must be cheerful, cooperative, flexible and patient. I agree to cooperate with the team leader(s) concerning our life together, including daily assignments, food, lodging, transportation, and other activities involving the team as a whole. I agree to stay with the team from the beginning to the end of the trip (except as excused by the team leader), to abstain from the use of alcohol while on the mission trip, and generally behave in a Christian manner. Applicants Signature Date TO BE COMPLETED BY THE APPLICANT S PASTOR: I believe that the above applicant is a dedicated Christian, a team player, and a friendly, flexible person who will make a valuable contribution to this mission team. I am/am not personally acquainted with the applicant and recommend him/her for volunteer mission service. Pastor s Signature Date APPLICATION AND REGISTRATION FEE TO BE MAILED TO JOHN BEST, 1253 DEERFIELD DRIVE, WILLIAMSPORT, PA 17701

3 VOLUNTEERS IN MISSION Williamsport District Susquehanna Conference - United Methodist Church MISSION-PURPOSE-TASK-GUIDELINES (To be retained by applicant) Mission: To make disciples of Jesus Christ for the transformation of the world. Purpose: Volunteers in Mission share Christ s love in ways that make a Christian difference. We witness through work by: Honoring God in all we do Living in community Experiencing the people Caring and listening Being flexible and patient Task: Our task is what we do (or the physical work we do) with our abilities and is always secondary to our purpose of making a Christian difference. Although our task is distinct from our purpose, the two are joined together so that Christ may be lifted up. Guidelines for Success: 1. In order to be true to our mission each event/day of work needs to be Christ-centered and Biblically based. Therefore, each day must begin and end with devotions and/or prayer. 2. Communicate with the team leader any changes, suggestions, or concerns. 3. Work to acceptable standards. Do the best you can, if not better! 4. Ask questions if you don t know how or what to do next. Remember there is no such thing as a dumb question. 5. Be respectful of other people s property. It might not be as nice as yours, but it is theirs. 6. Don t assume you know the plan for the entire project. Ask before you start additional work. 7. Keep workspaces and living spaces neat and clean. 8. Wear appropriate clothing and sensible, safe shoes. 9. Foul or undesirable language is not permitted. 10. Don t criticize, gossip or start rumors. Remember we are there to show God s love. 11. No drugs, alcohol or other illegal substances are permitted at any time. (Failure to comply with these guidelines could result in your dismissal from VIM) We are privileged to have the opportunity to serve our great God by being volunteers in mission. Our primary purpose as volunteers is to radiate the love and hope of Jesus Christ. We are to invest ourselves in the mission and honor God in all we do and say. We will need to be flexible, adaptable, sensitive, and patient. There will be times when we may want to hurry and get things done but delays happen. Flexibility and co-operation are the keys to a great experience.

4 Return to Team Leader Emergency Contact Information Volunteer s name Date of birth Mailing address Home phone Work phone IN CASE OF EMERGENCY, CONTACT THE FOLLOWING: Name Relationship to volunteer Address City / State / Zip Home phone Work phone IF UNABLE TO CONTACT THE ABOVE, CONTACT THE FOLLOWING: Name Relationship to volunteer Address City / State / Zip Home phone Work phone OTHER INFORMATION YOU WISH TO ADD IF AN EMERGENCY ARISES:

5 Team Member Packing List (To be retained by applicant)! Recommend a plastic stackable container (24 x16 x16.5 ) for clothes instead of suitcase! Plate, bowl, fork, knife, spoon, drinking cup and/or water bottle (Each person may need to prepare own breakfast, pack own lunch and do their own dish washing)! Vaccinations (make sure your TETANUS shot is current)! Clothing (work and casual) Include some long sleeved shirts or sweat shirts! Comfortable work shoes! Hat for working in the sun, sunscreen, sunglasses! Work gloves! Rain gear (check weather forecast)! Air Mattress or cot, sleeping bag and pillow)! Towel and wash cloth! Flashlight! Bible! Notebook, pencil/pen! Cash (for meals, snacks, etc. for trip down and back, or other things you want to purchase)! Medications that you may need! Copies of prescriptions of drugs you are taking with you! Ear plugs (some people snore)! Extra pair of glasses and/or contacts; extra hearing-aid batteries! Insect repellent! Toiletries, e.g., soap, shampoo, lotion! Desire to love as Christ loves, positive attitude, Christian spirit, and servant mentality Reminder: Leave travel schedule and phone numbers with family or other contacts at home.

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7 MEDICAL AUTHORIZATION and INFORMATION FORM (FOR ADULT) Williamsport District Volunteers In Mission Susquehanna Conference of the United Methodist Church I, (volunteer participant) hereby appoint as my agent and (other adult on trip) representative for the purpose of authorizing and consenting to any necessary examination, anesthetic, medical diagnosis, surgery, or treatment and/or hospital care rendered to me under the general or special supervision and on the advice of any physician or surgeon licensed to practice medicine by the state (or country) in which they practice, during the duration of the trip identified below. NAME & LOCATION OF PROJECT: MARCH 2015 MISSION JOURNEY TO SWANQUARTER, NC Dates of Trip: MARCH 22 28, 2015 Participant s Physician Physician s Telephone Allergies and Medications Blood Type Diabetic? yes no Seizures? yes no Medical Insurance (Insurance Carrier) Phone (Policy Number) Please provide any other helpful medical information: I consider myself healthy enough to fulfill my responsibilities on the mission team. Signature of Participant Date

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