Adult Application - De Pere ...
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Adult Application
ADULT APPLICATION Due by August 30, 2020
• The trip dates are tentative and may be changed, by a day or two, due to airline or missionary
schedules.
• The price for the trip includes: round-trip transportation, lodging, meals, and insurance. This is an
estimated amount and could increase due to unexpected lodging fees, parking fees, or other costs of
traveling in a foreign country. Personal Spending Money is not included in the price.
• This trip is open to all Destiny Church youth and adults who are fifteen years and older who have been
approved by our Missions Department via this application. (13-14 year old students may join this trip
only if their parent/legal guardian is also on the team)
• Because of limited space, applications will be processed on a first come/first serve basis.
Application Checklist
Before turning in your application, be sure to complete the following:
Incomplete applications will be returned and you will be moved to the bottom of the list (space is
limited)
APPLICATION: Make sure you have completed pages 3 & 4 of the application to the best of your ability.
Be sure to include all signatures and your t-shirt size. These two deletions can delay processing.
TESTIMONY/SPIRITUAL INFORMATION: Page 4 of the application requests spiritual information from
you. Please type your testimony and attach on a separate piece of paper.
PHOTO: Attach a current school type photo of applicant. It is always a good idea for the trip leader to have
a current picture of all students on the trip in case of emergency.
WITNESSES: Page 6 of the application must be signed with two witnesses present
$200 DEPOSIT: The deposit check can be a personal check. Please make all checks payable to “Destiny
Church” and write the students name on the memo line; the $100 will be applied to the balance of the trip
cost. The deposit is non-refundable, unless Applicant is declined.
$1800 TOTAL: The total cost for the trip is $1800. This can be paid at the time of the deposit, or by using
the schedule below. Like the deposit, please make all checks payable to “Destiny Church” and write the
students name on the memo line.
Accounting Procedures:
• Anyone contributing to your trip should make their check payable to “Destiny Church”.
• Each check should have the birth name of the trip member and “DR 2020” in the memo line.
• It is the Applicant’s responsibility to keep a record of all people who contributed to
his/her trip.
AMOUNT DUE PAYMENT SCHEDULE
DATE DUE
$200 Deposit August 30, 2020
$1000 Payment September 13, 2020
$600 Payment October 18, 2020
DR 2020 Adult Application Page 2 of 72020 Adult Application
(to be completed by any applicant 18 years and up)
INDIVIDUAL INFORMATION
Legal Name as it appears on your Driver’s License or State issued ID:
Last ________________________________ First _____________________________ Middle ______________
Name you go by if different from your legal name __________________________________________________
Home Address __________________________________ City _________________ State ___ Zip _________
Home Phone (_____) _______________________ Cell Phone (________) ____________________________
What is your shirt size (adult sizes only)? (Please circle one) S M L XL XXL
Birth date (MM/DD/YYYY) ______/_______/___________ Age _______(as of trip date)
Email address ______________________________________________________________________________
FAMILY INFORMATION
Spouse Name _____________________________________________________________________________
Spouse Contact Number (_____) _____-________
Names of Children __________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
CHURCH AFFILIATION
Do you attend Destiny Church? yes / no
If “no” please continue:
Pastor _____________________________________ Church Name __________________________________
Address_________________________________ City ___________________ State _____ Zip _____________
Phone (_________) ________________________ How long acquainted? _______________________________
HEALTH INFORMATION
1. What type of health are you in? ____ Excellent ____ Good ____Fair ____ Poor
Explain _____________________________________________________________________________
2. Is there any history of emotional, mental or physical handicaps? ___ Yes ___ No
If "YES" explain _______________________________________________________________________
3. Do you use alcohol, tobacco, or illegal drugs? ___ Yes ___ No
If "YES" Explain ________________________________________________________________________
DR 2020 Adult Application Page 3 of 7MISCELLANEOUS INFORMATION
1. Will you be willing and able to eat whatever food you are served? ___ Yes ___ No
If no, please explain your diet requirements __________________________________________________
_____________________________________________________________________________________
SPIRITUAL INFORMATION
Please use a separate sheet of paper and type a brief account, no more than 2 pages of the following:
1. Your spiritual experience
A. Salvation, water baptism, and in-filling of the Holy Spirit. Relate how, when and where for each.
B. Tell us about your present involvement in your church: How long you have attended? Your faithfulness
to Destiny activities? Do you tithe, give to missions (Faith Promise, BGMC, S.T.L.), etc.?
C. Tell us about your spiritual walk: where you are now, where you are going, when and how you share
your faith in Jesus Christ with others, etc.
D. How often do you read your Bible and pray during an average week?
E. What method of Bible study are you now using?
F. Do you feel a calling on your life? If so, what is it?
2. Your experience in Christian work
A. What have you done: when, where, and with whom have you worked.
B. List particular examples of leadership experience.
C. List anything else you feel we should know about you.
3. In a paragraph list your reasons for wanting to participate in this outreach.
Be sure ALL FORMS are complete and turn them into the church office. If you are mailing in your
application send it to:
Destiny Church
Attention Missions Department
411 Destiny Drive
De Pere, WI 54115
If you have any questions regarding the trip
or this application, please call (920) 336-7910 ATTACH A CURRENT
SCHOOL TYPE
PHOTO HERE
DR 2020 Adult Application Page 4 of 7Assumption of Risk Form I, ________________________________ (name of volunteer), in consideration of my acceptance as a Missionary-Volunteer of Destiny Church represent and agree that: 1) I am a volunteer worker and not an employee of Destiny Church 2) I am aware of the hazards and risks to my person and property associated with serving in a missions capacity, such hazards and risks including, but not being limited to death or injury by accident, disease, war, terrorist acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. I accept my assignment as a Missionary-Volunteer with full awareness of these risks, and , subject to any insurance coverage that may be available to me from any source, and I voluntarily assume all risks of death, injury, and illness associated with such risks, and any damage to my personal property, and I release Destiny Church and its agents, officers, directors, pastors, and employees from any liability whatever raising as result of death, injury, or illness that I may suffer as a result of participation in the missions project. I further recognize that such risks have always been associated with missionary service. 2 Corinthians 11:23-28 3) I attest and certify that I have no medical conditions that would prevent me from performing my duties as a Missionary-Volunteer. 4) I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal valid and binding obligation upon me enforceable against me in accordance with it’s terms. 5) I am aware of the hazards and risks to my person associated with participation with Destiny Church as a Missionary-Volunteer, as described above. I further understand that Destiny Church may not have any insurance coverage that would apply in the event of my death, illness, injury, or damage to my property that may occur during my participation as a Missionary-Volunteer, and if I desire insurance coverage I am responsible for the cost of such insurance. 6) I expressly agree that this assumption of risk is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FORGOING ASSUMPTION OF RISK AND UNDERSTAND THE CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I HVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING IT. Date (mm/dd/yyyy)_______________________ Signature ________________________________________ Address _________________________________________________________________________________ City ________________________________ State ____________________ Zip ______________ DR 2020 Adult Application Page 5 of 7
IMPORTANT: Please have 2 witnesses observe your signature, and have them sign below. They must be at
least 18, and should not be relatives.
Witness ________________________________ Witness ________________________________
Address ________________________________ Address ________________________________
City ___________________________________ City ___________________________________
State & Zip ______________________________ State & Zip ______________________________
Media Release Form
I ____________________________________________ give Destiny Church my permission to be
recorded on different medias for future use in promotions, services, Church social media, website,
and publications of Destiny Church and/or its Missions Program.
Date (mm/dd/yyyy)_______________________ Signature ________________________________________
Address _________________________________________________________________________________
City ________________________________ State ____________________ Zip ______________
IMPORTANT: Please have 2 witnesses observe your signature, and have them sign below. They must be at
least 18, and should not be relatives.
Witness ________________________________ Witness ________________________________
Address ________________________________ Address ________________________________
City ___________________________________ City ___________________________________
State & Zip ______________________________ State & Zip ______________________________
DR 2020 Adult Application Page 6 of 7Medical Information Name: _____________________________ Date of Birth ____/_____/_________ Person to Notify (Emergency Contact): Name: _________________________________________________________________________________ Relationship: ___________________________________________________________________________ Address: ___________________________________________________________________________ Telephone: Cell (_____) _____-_______ Work/Home (_____) _____-_______ Medical Conditions: ______________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Current Medications: ______________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Known Allergies: ______________________________________________________________________ ________________________________________________________________________________________ Blood Type (if known) _____________________________ Physician’s Name: ______________________________________________________________________ Address: ____________________________________________________________________________ Telephone: ____________________________________________________________________________ Medical Insurance: ______________________________________________________________________ Policy Number: ______________________________________________________________________ DR 2020 Adult Application Page 7 of 7
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