First, Middle, and Last Name: *

First Name

Last Name

Phone: *

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Birthdate: *

MM

DD

YYYY

If you are under 18, please list your parent or guardian's name:

First Name

Last Name

Parent/Guardian Phone:

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Do you have a passport? *

Yes!

No, how do I get a passport?

No, but I have turned in my passport application.

How would you rate your physical fitness? *

Great - I can carry over 40 lbs and rock out manual labor jobs

Average - I'm fairly active in my daily life and can do some manual labor

Below Average - Manual labor jobs will be a challenge for me

Please list the name of one reference whom One 17 International can contact: *

First Name

Last Name

Reference Phone Number: *

(###)

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Trip Conduct: If accepted as a member of a One 17 International serving team, I agree to: 1) Remember that I am representing One 17 International and, more importantly, Jesus Christ. I will model Jesus in my behavior and attitude.
 2) Remember that we have come to learn, as well as teach. I will resist the temptation to inform others about “how we do things.” I will be open to learning about other people’s methods and ideas. 3) Respect everyone’s view of faith, Christianity, and religion, recognizing that it has many faces throughout the world and that part of the purpose of this trip is to experience faith lived out in a new setting. 4) Develop and maintain a servant attitude toward all nationals and my teammates. 5) Respect my team leader(s) and her/his decisions. 6) Refrain from gossip. 7) Refrain from complaining. I know that travel can present numerous unexpected and undesired circumstances, but the rewards of conquering such circumstances are innumerable. Instead of whining and complaining, I will be creative and supportive. 8) Attend all team meetings before trip as well as any follow-ups. Complete all training readings, forms, and requests made by the trip leader or coordinator. 9) Remember not to be exclusive in my relationships. If my boyfriend/girlfriend or spouse is on the team, we will make every effort to interact with all the members of the team. If I am attracted to a teammate, I will not attempt to pursue a relationship until after we return home. 10) Refrain from any activity that could be construed as romantic interest in a national or teammate. 11) I am not involved with illegal drugs, and I will not consume alcohol or use tobacco products while on this trip. 12) I agree to abide by the fund procedures (money due dates) endorsed by One 17 International and will personally thank all financial donors that contribute to my trip. 13) I agree to allow One 17 International to use any photos or videos taken of me while serving in the mission field or during trip training for storytelling, promotional, and marketing purposes.
 14) Remember that I can be sent home at my own expense if I do not adhere to this Conduct Agreement or if my Team Leader believes it is in my best interest or that of the team. *

Yes, I agree

No

General Liability Release: In signing this form, I agree not to hold One 17 International, her officers, employees, or other agents liable for any injury, loss, damage, or accident that I might encounter while on a short-term missions event/effort. I realize and acknowledge that my participation on a serving trip (mission trip) to a foreign country includes risk and possible dangers. I am well aware that my travel to such a foreign country exposes me to such risks as accidents, disease, war, political unrest, injury from construction projects, and other calamities. I hereby assume any such risks that might result from my participation in a short-term mission project, and I unconditionally agree to hold One 17 International, its officers, employees, or other agents blameless for any liability concerning my personal health and wellbeing, or any liability for my personal property that might be lost, damaged, or stolen while on a short-term mission trip. *

Yes, I release liability

No

Today's Date: *

MM

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