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UNIVERSITY OF THE CUMBERLANDS
BCM SPRING BREAK MISSION TEAMS

Saturday, MARCH 9—Saturday, MARCH 16, 2013

Download Informational Flyer

Missions

APPLICATION AND DEPOSIT OF HALF THE TRIP COST IS DUE:  February 20, 2013
BALANCE FOR TRIP IS DUE:  March 1, 2013

 

 

CONTACT INFORMATION:
Name
  First Middle Last
Are you authorized to drive a UC vehicle? Yes    No                                        Driver's License #
Cell Phone
Email
T-Shirt Size
Dorm/Street Address
Post Office Box
Permanent Address
Street Address
City State Zip

Are you trained in Disaster Relief work?     Yes    No

If not, are you interested in becoming trained?      Yes    No


PARENT/GUARDIAN INFORMATION:
Name(s) Home Phone
Email Address Work Phone
Address Cell Phone

PERSONAL INFORMATION:
CHURCH ACTIVITIES AND/OR MINISTRIES YOU HAVE SERVED WITH, SPECIFICALLY RELATING TO CHILDREN, YOUTH, ETC:

 

RANK FROM 1-5 (WITH 1 BEING HIGHEST) THE TEAM(S) TO WHICH YOU SENSE YOU ARE BEING CALLED TO SERVE:

   KENTUCKY  (work with children’s home, women in crisis, etc.)

  ILLINOIS  (work with youth revival and ministry in inner city with churches)

  BEACH REACH  (work reaching peers who have come to the beach to party for their break)

  COLORADO  (work doing children’s VBS and Kids’ Clubs using face painting, ballooning, etc.)

  NEW YORK   (work tutoring English to immigrants from Africa, Asia, and other religious backgrounds)

 

WHY DID YOU RANK THE ABOVE TEAMS AS YOU DID?

 

OTHER MISSION OR FOREIGN TRAVEL EXPERIENCE:  EVENT OR COUNTRY, DURATION, PURPOSE, & YEAR:

 

If you have now or have ever had any of the following medical conditions, please indicate and explain:
asthma heart trouble   migraine headache
diabetes nervous disorders    psychiatric treatment
tuberculosis stomach/digestive disorders thyroid disease
wear contacts  other:

 

Other chronic medical conditions:

 

Current status of any condition listed above:

 

Overall Present Health:   

Overall GPA: Major: Minor:
Intended month and year of graduation from University of the Cumberlands:

SPIRITUAL INFORMATION:
Share a brief testimony of how you came to know the Lord. Please include how you are continuing to grow as a Christian.
Give a response below as to why you believe you are being called to serve on this particular mission team over break.

FINANCIAL INFORMATION:

Upon acceptance to the team:
All financial arrangements are to be made through the Office of Campus Ministries at University of the Cumberlands.

Mission Trip participants are responsible for:  1.) all expenses posted for each respective trip, and 2) personal expenses associated with the program including any required immunizations and the cost of a passport (for international trips only) as well as any money for souvenirs or incidentals.

Your signature below certifies that you have read, understand, and agree to this portion of the application.

I hereby certify that all information related in this application is accurate. If selected for participation in this program, I will conduct myself in a manner that honors the ideals of Christian servant leadership and in accordance with the policies of University of the Cumberlands in all matters academic, social, and legal, as stated in the University of the Cumberlands Student Handbook and the University of the Cumberlands Catalog.  My signature below serves to certify that I am prepared to meet the expectations stated in these publications.

Signature of Applicant: Date:

THE FOLLOWING IS REQUIRED OF ALL APPLICANTS FOR INTERNATIONAL MISSIONS AND ANY STUDENT UNDER THE AGE OF 18.   APPLICATIONS WILL NOT BE PROCESSED WITHOUT THE SIGNATURE OF PARENT OR LEGAL GUARDIAN BELOW AS REQUESTED.

I certify that I am the parent or legal guardian of the above applicant, and that I have read the foregoing application and the information provided by the applicant. I attest to the truthfulness of the information provided. I attest that I understand the financial, academic, and social expectations as detailed above. I attest that I release University of the Cumberlands, Baptist Campus Ministries, the Kentucky Baptist Convention, and from any responsibility for my child in the event this child departs from the scheduled program. Finally, I do waive and release all claims against University of the Cumberlands, Baptist Campus Ministries, Kentucky Baptist Convention, or their agents, any tour organizer or arranger employed or utilized by University of the Cumberlands, Baptist Campus Ministries, or Kentucky Baptist Convention, for any injury, loss, damage, accident, delay or expense resulting from the use of any vehicle, any strike, war, weather, sickness, quarantine, government restrictions, or regulations arising from any act or omission of any steamship, airline, railroad, bus company, taxi service, hotel, restaurant, school, university, or any other firm, agency, company, government or individual. I also release University of the Cumberlands, Baptist Campus Ministries, Kentucky Baptist Convention, and/or their agents, and agree to indemnify them with regard to any financial obligations or liabilities that I may personally incur or any damage I incur to the person or property of others that I may cause, while participating in this missions program.

Signature of Parent/Guardian: Date:

 

 

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