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Guachochi, Mexico
November 5, 2018-November 12, 2018
Fully Staffed
Back to Guachochi, Mexico
Study guide for this trip
Module 4: Church History
Apply for this trip:
Step 1 of 5
20%
Questions about this application?
Contact Scott Mescher at
[email protected]
with any questions.
Personal Information
Preferred departure city and airport:
*
Full name as it appears on passport:
*
Passport Country of Issue:
*
Passport Number:
*
Passport expiration date:
*
Date of birth:
*
Preferred name:
*
Email address:
*
Home phone:
*
Work phone:
Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
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Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
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Italy
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Jordan
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Latvia
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Liberia
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Lithuania
Luxembourg
Macau
Macedonia
Madagascar
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Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Beneficiary name(s) and relationship (for trip insurance purposes):
*
Responsibility
For international trips, a part of the cost you are paying covers the purchase of medical and medical evacuation insurance available through Arthur J. Gallagher & Co. While Reaching and Teaching International Ministries (RTIM) is not responsible for benefits paid under the insurance plan, you are designating RTIM to file claims and communicate with the insurance company if needed. RTIM is acting only in the capacity of agent and facilitator in matters of transportation and mission operations. RTIM assumes no responsibility for injury, damaged or lost of property, or other losses/expenses caused by delays, sickness, quarantine, airlines, other transportation companies, or from other individuals, companies, or circumstances not controlled by RTIM. RTIM reserves the right to make alterations in the itinerary. RTIM also reserves the right to accept, decline, or retain any person as a member of the mission trip at any time.
Please enter your initials below to indicate you have read and understand this statement.
*
Date:
*
Conduct
A condition of acceptance for a Reaching & Teaching trip is affirmation of and submission to the Personal Covenant & Liability Release Form. Your affirmation of that document (available below) indicates that you have read and agree to submit to every item included on the document. This includes the commitment to submit to the Reaching & Teaching trip leader in all matters, abstain from pursuing romantic relationships with team members or nationals, abstain from using alcohol or tobacco for the duration of the trip, and to act as a servant-disciple of the local ministry.
Personal Covenant and Liability Release Form (PDF)
Please enter your initials below to indicate you have read and understand this statement.
*
Date
*
Risk
I understand that any mission trip includes an inherent level of explicit and implicit risk. Travel accidents, sickness, and injuries are among these risks. Further, I have reviewed the information about the mission trip country found on the Consular Sheets produced by the U.S. State Department at the following Web site (http://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html). I knowingly accept the risks of participating in this mission trip.
Please enter your initials below to indicate you have read and understand this statement.
*
Date
*
Health Questions
Blood Type:
*
O +
O -
A +
A -
B +
B -
AB +
AB -
Family/Personal Physician:
Physician Phone:
Emergency Contact Name:
*
Emergency Contact Email:
*
Emergency Contact Phone
*
Do you have any chronic or current health problems that might be affected by the enviornment and living conditions in a third world country?
*
Yes
No
If yes, please explain.
Have you ever had any serious injury or illness?
*
Yes
No
If yes, please explain.
Are you receiving medical treatment for any chronic ailments?
*
Yes
No
If yes, please explain.
Are you currently taking medications?
*
Yes
No
If yes, please explain.
Do you have a history of trauma or abuse?
*
Yes
No
If yes, please explain.
Do you use alcohol?
*
Yes
No
Do you use tobacco?
*
Yes
No
Have you ever had, or have now, any of the following?
Frequent and/or severe headaches?
*
Yes
No
If yes, please explain.
Convulsions?
*
Yes
No
If yes, please explain.
Mental Problems?
*
Yes
No
If yes, please explain.
Asthma?
*
Yes
No
If yes, please explain.
Epilepsy?
*
Yes
No
If yes, please explain.
Heart Problems?
*
Yes
No
If yes, please explain.
Breathing Problems?
*
Yes
No
If yes, please explain.
Back or Neck Problems?
*
Yes
No
If yes, please explain.
Foot Problems?
*
Yes
No
If yes, please explain.
Dizziness or Fainting?
*
Yes
No
If yes, please explain.
Nervous Breakdowns?
*
Yes
No
If yes, please explain.
Depression?
*
Yes
No
If yes, please explain.
Anxiety Attacks?
*
Yes
No
If yes, please explain.
Gastroenterological Problems?
*
Yes
No
If yes, please explain.
Ulcers or Hernias?
*
Yes
No
If yes, please explain.
Digestion Problems?
*
Yes
No
If yes, please explain.
Vision Problems?
*
Yes
No
If yes, please explain.
Allergies?
*
Yes
No
If yes, please explain.
Hearing Difficulties?
*
Yes
No
If yes, please explain.
High/Low Blood Pressure?
*
Yes
No
If yes, please explain.
Joint Problems?
*
Yes
No
If yes, please explain.
Ministry and Service
In which of these areas do you feel God has gifted you? (Please check all that apply.)
*
Personal Evangelism/Witnessing
Preaching
Teaching
Children's Ministry
Other
If other, please explain.
Church to which you belong:
*
Are you a Pastor on Staff:
*
Yes
No
Church Address:
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Pastor's Name (if you are the pastor, simply put your name):
*
Church ministries in which you have been actively involved over the past 2 years:
*
Other ministry experience that would be helpful for us to know:
Reference 1:
*
First
Last
Phone
*
Email
*
Reference 2:
*
First
Last
Phone
*
Email
*
Reference 3:
First
Last
Phone
Email
Please list any formal ministry or theological training you have received:
Mission Trip Experience
Have you ever gone on a mission trip?
*
Yes
No
If yes, briefly describe your involvement and where you served:
Testimony
Please share the circumstances surrounding how the Lord saved you. Include how you heard the gospel, understood your need for forgiveness, relevant scripture passages that were instrumental, etc.:
*
Please share how you heard about Reaching & Teaching and why you want to serve on this trip:
*
Reaching & Teaching Statements of Belief
I have read and agree to serve in accordance with and not contrary to the Abstract of Principles and the Baptist Faith & Message (2000) while serving with Reaching & Teaching International Ministries. Please initial below to indicate your agreement with this statement: To continue your application process, please read through the
Reaching & Teaching Statement of Beliefs and The Baptist Faith and Message
.
Initials
*
Date:
*
