Post on 30-May-2018
transcript
8/14/2019 Short Term Missions Team Application
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Short Term Missions Team Application
Thank you for your interest in short-term missions with FBCSLO! The goal of every missionsactivity we undertake as a church is to equipyou to shine Gods glory to the world. Ourcommitment to you is that, by going on this trip, you will be trained to recognize and seize
opportunities to share the love of God through Jesus Christ. And we trust that when we go inHis name, God is pleased to use us to bring many to Himself.
In this application packet, you will find a number of important documents. Please readthrough them carefully and fill them out completely. The checklist below will help you be surethat you have read and completed all necessary forms:
All Short Term applicants:
Short Term Team Member Application Medical Information Form
Adult Release of Liability Form Team Covenant Pastor/Leader Reference Forms Travel & Financial PoliciesCollege Students and Minors:
Parent Letter & Advice Form Parental Consent and Release of Liability (only for those under 18)
It is very important that you read each document thoroughly and provide your
signature in the areas noted.
Your application is not considered completed until all of the above documents have beencompleted and submitted to the Missions Director, along with the non-refundable $75.00 tripdeposit (payable to FBCSLO) at:
Missions Director
First Baptist Church, SLO2075 Johnson Ave
San Luis Obispo, CA 93401
If you have any questions about any of these documents or short term missions at FBCSLO,please contact Ben Barczi at 805.550.7260 or ben@fbcslo.org.
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Short Term Missions Team ApplicationFirst Baptist Church, SLO Vintage Community Church 805.543.0945
Please fll out the ollowing legibly in ink. I you have any questions, contact Ben Barczi at 805.550.7260.
Date o Application Applying or which trip?
Personal Inormation
Name
Street Address
City ZIP
Home Phone Cell Phone
Email:
Date o Birth Place o Birth
Marital Status: Single Dating Engaged Married Widowed Separated Divorced
Citizenship & Passport Inormation
Are you a US Citizen? Yes No I no, o what country are you a citizen?
Passport Number/Issue Date I do not have a passport
Passport Expiration Date I need to renew my passport
Relationship to FBCSLO & Vintage Community
Check one and complete the requested inormation:
Member since: Regular attender and active in church since:
Occasional attender Involved in another church (speciy):
List FBCSLO/Vintage pastors, elders or leaders who know you best and could serve as reerences (list leaders rom other churches as well,
along with contact inormation):
List FBCSLO/Vintage ministries you have been involved with, both past and present (include length o involvement or each ministry, andministry leader.)
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What missions books or periodicals have you read recently?
I you have been on previous short-term trips, describe what you have done in missions since your last trip (ie, books read, conerences at
tended, ministries you are a part o, missionaries supported, etc.)
Your expectations greatly inuence the success o a short term missions trip. Over the months ahead, the training you will recei
will help refne your expectations and equip you to share your aith. We would like your initial thoughts (use additional sheets o
paper i needed).
Why are you applying or this team?
What impact are you anticipating that this trip will have on your relationship with God?
How do you think your involvement will strengthen the team?
Describe the type o relationships you hope to build with the people you will be ministering to:
What impact do you expect the team will have?
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Describe how you would explain the gospel to a non-believer.
What part do you think you should play in evangelism on this trip? How prepared do you eel to accomplish this role?
Statement o Faith
Below is the FBCSLO & Vintage Community statement o aith. Please read it and respond below.
We believe that the sovereign, triune God created the world out o nothing. The heavens and all the earth are His handiwork. Man and
woman were made in His image.
God gave Adam and Eve important work to do in His world as His representatives on earth. Sin entered the world because Adam and Eve
disobeyed God and tried to be like Him. By nature all people, thereore, are estranged rom God and live in a world corrupted by sin. But,in Jesus Christ, God has provided redemption and orgiveness or those who repent and believe. Forgiveness comes through the sacrifce
o Gods Son, Jesus Christ, who was born in our esh, who took our place in His death, who rose rom the dead and now sits in glory at HisFathers right hand. There he intercedes and prays or His people. In the Spirit, He comes to us here and now, and gathers those whom H
has redeemed into His church. Through His Spirit, Jesus is directing Gods great work o making all things new.
With all believers, we long or that day when Jesus will return as triumphant King. Then, He will gather us to himsel as one new amily inChrist Jesus and throughout eternity ully enhance the lives o His children as citizens o His kingdom, sons and daughters in their Fathershouse. We ace that day without ear, or the Judge is our Savior and Lord! To Him be the glory!
Do you agree with this statement o aith? Yes No
I no, please explain:
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Deposit Inormation
Please include your non-reundable deposit in the amount o $75.00 with this application orm. Make check payable to FBCSLO.
Disclaimers (please read and initial):
___ I have read and agree to the attached payment schedule or the trip I am applying or. I understand that i I cancel my participation the trip, I will remain responsible or any payments due up until that point.
___ The travel agency or FBCSLOs Missions Department will not be responsible or any extra trip expense (ie, airline or hotel are chang-
es.) Should these occur, they will be passed along to the traveler.
___ I will agree to return home at my own expense i the team leadership determines that my behavior is/has been inappropriate.
___ I I decide to cancel my participation on a team ater airline tickets have been purchased, I will be responsible or the cost o the tickeas well as any cancellation expenses.
In submitting this application...
I am expressing my agreement with the attached Team Covenant.
I will, Lord willing, attend all training sessions and complete all training requirements.
I whole-heartedly submit to the team leadership and will ollow their direction and instruction.
I am willing to work under the direction o missionaries and national pastors to accept and to perorm any and all assignments cheerully.
I will be exible, adjusting my demeanor, posture and manner as needed.
I am willing to conorm to the standards o the national Christians, even i those standards are stricter than my own.
I have read and agree to the above deposit, payment inormation, and the fnancial policies described in FBCSLOs Short Term Team TravelFinancial policies document.
I have read and agree to the above disclaimers.
Signature:
Date:
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Short Term Missions Medical InformationFirst Baptist Church, SLO Vintage Community Church 805.543.0945
Please fll out the ollowing legibly in ink. I you have any questions, contact Ben Barczi at 805.550.7260.
Name
Medical Insurance
Insured Name Membership Number
Insurance Company Name Group # Company Phone
In Case of Emergency, please notify...
PRIMARYCONTACT
Name SECONDARYCONTACT
Name
Address Address
City/State/ZIP City/State/ZIP
Phone Phone
Relationship Relationship
All team members going on a short term trip will be required to purchase travel insurance. This will be included in the cost of th
trip. For more information on this, please see the Travel and Financial Policies.
Medical Information (please use additional sheet of paper if needed for explanations)
YES NO
Are you currently ill or undergoing any medical treatment (including medications)? Explain:
Do you have any allergies (foods, medications, hay fever)? Explain:
Do you have any daily mandatory medical needs (including medications)? Explain:
Are you in any way physically or mentally handicapped? Explain;
Do you have back problems? If so, explain:
Do you have any problems not already mentioned which might hinder you during this trip? Explain:
Do you have any special dietary needs or requirements? Explain:
What is your blood type?
Is your tetanus shot current? Date of latest tetanus shot:
Note: depending on health situation, some applicants may be asked to have a physical examination beore going on a short term tea
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FBCSLO & Vintage Community
Adult Short Term Ministry Trip
Release of Liability
I realize and acknowledge that my participation in a mission trip to a foreigncountry includes many risks and possible dangers. I am well aware that my
travel to a foreign country exposes me to risks including, but not limited to
accidents, disease, war, political unrest, and natural disasters.
I expressly agree that all activities associated with the short term missions trip
sponsored by First Baptist Church SLO and Vintage Community Church to
__________________________ from ____________ to _____________ are
undertaken by me at my sole risk, and that First Baptist Church SLO and Vintage
Community, its servants, officers, employees, or agents, shall not be liable for
any claims, demands, injuries, damages, or causes of action to me or my
personal property arising out of the above-described activities associated with
the above-described short term ministry trip and I hereby expressly forever
release and discharge First Baptist Church SLO and Vintage Community, its
servants, officers, employees, or agents from all such claims, demands, injuries,
damages, or causes of action arising from acts of active or passive negligence on
the part of First Baptist Church SLO and Vintage Community, its servants,
officers, agents, or employees.
Signed ____________________________________(Team Members Signature)
Dated _____________________________________
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Short Term Missions Team Covenant
We, the members of a First Baptist Church Short Term Missions Team, believing that God has called us together
to serve, agree together concerning the following:
I. Our Vision
We desire to be a team of people characterized by Christ like behavior exhibited through unconditional love;
unselfish, joyful service, and unified teamwork. Our ultimate purpose as a team is to be used by God to bring
others to a saving relationship with Christ, so they may grow in love for Him, love for His church and love for His
world.
II. Our Team Objectives
We believe that we can fulfill this vision through the following commitments:
A. Glorifying God: We join God the Father in magnifying the supremacy of His glory through our Lord Jesus
Christ, in the power of the Holy Spirit by treasuring all that God is, loving all whom He loves, praying for all His
purposes, meditating on all His Word, sustained by all His grace (Psalm 115:1-3; John 17:3, 17, 23).
B. Our Teamwork: We commit ourselves to being a group of individuals who unite as one in purpose, striving toaccomplish the same goal: to glorify Christ and increase His Church (1 Corinthians 12:12-31).
C. Communication: We commit ourselves to resolve all inter-team conflicts according to biblical principles. This
involves prayer as the first step, personal confrontation as the follow-up step, and the counsel of a third party
(namely, a leader) as a third and final resort (Matthew 18:15-20). In all issues of conflict, we commit ourselves
to maintain a humble spirit of confidentiality, while seeking to affirm one another in love (Ephesians 4:29;
Colossians 4:6).
D. Forgiveness: We commit ourselves to the recognition of sin as our common enemy so that we each may be
sensitive to our human failings and forgive each other (Ephesians 6:12; Colossians 3:12-13). We recognize that
forgiveness is manifested through an understanding, forgetful attitude and the continuation of
demonstrated love. In accordance with Hebrews 12:15, we commit ourselves to resolving any bitterness,
because we realize that bitterness will drag the whole team down (Matthew 18:21-35).
E. Spiritual Growth: We commit ourselves to personal worship and fellowship with God through obedience to
the Lordship of Jesus Christ and an openness to learn from Gods Spirit in all situations. We agree to have the
same attitude of the Apostle Paul with respect to failure (Philippians 3:12-14), and with respect to
perseverance (1 Corinthians 9:24-27); we will strive to put off the old self (Ephesians 4:17-22) and put on the
new self (Ephesians 4:23-32).
III. Our Team Structure
We believe that the following structure elements will enable us to carry out our team objectives:
A. Team Meetings: Before, during, and after the trip, our team meetings will be crucial for fulfilling the
commitments mentioned above. These team meetings shall include team devotions, team prayer, time for
communication of details and plans, and time for individual relational development (Hebrews 10:24;
Ephesians 5:19-20).B. Personal Quiet Times: We will attempt to be faithful in our daily times with God because we believe that
growing individually is essential to growing as a team (Hebrew 10:22).
C. Ministry Training: We will seek to be a witness of the love of Jesus to the people we encounter throughout our
trip. To do this, we will participate fully in training before and during the trip so that we can be fully equipped
for ministry opportunities.
D. Work: We recognize that, if our objectives are to be completed, we must all commit ourselves to work to the
best of our God-given ability every day of the project (1 Corinthians 10:31).
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E. Prayer: We commit ourselves to daily prayer, every day up to and including our time on the field, for the
individuals on our team, the missionaries we will serve with, and the national church.
F. Leadership: In situations of team concerns, the team leader will be the team guide. We also recognize that
working with the team is an opportunity for us all to develop God-given leadership ability, and we commit
ourselves to that end through the pursuing of individual growth opportunities that may arise (Ephesians 5:21;
Hebrews 13:17).
G. Lifestyle: We will strive (God helping us) to be imitators of Christ (1 Corinthians 11:1), to walk as He would walk
(1 Peter 2:21), not causing our brother to stumble (1 Corinthians 8:9-13), acting in a manner appropriate to
the host culture, doing all for the glory of God (1 Corinthians 10: 31).
IV. Evaluation/Accountability
We shall hold each other accountable to this Covenant, and we shall measure our success in keeping this
covenant by the following:
A. Correcting each other according to biblical and covenant principles (Colossians 1:28; Matthew 18:15-18;
Galatians 6:1; 1 Corinthians 5).
B. Responding without defensiveness when we are corrected, believing that other team members have our best
interests and of the team in mind (Proverbs 27:5-6).C. Meeting as a team after our return home to debrief as a team.
I, ____________________________________, as a member of a FBC Short Term team, commit myself to abide by
this covenant to the best of my God-given ability.
Signed: _________________________________________
Date: _________________________________________
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Please give form to two leaders and/or someone who knows you well. If under 18, one should be from a parent/legal guardian.
Please return this form to: Missions Department First Baptist Church, SLO, 2075 Johnson Ave, San Luis Obispo, CA 93401.
SHORT TERM MISSIONS TEAM REFERENCE FORM
Applicant ________________________________ Your relationship to the applicant _____________
Thank you for taking the time to fill out this form. It is important that you be as candid as possible in your responses. If
you need more space, please use a separate piece of paper and write the applicants name at the top of that sheet. If you
would like to discuss an issue that might relate to a particular question, please call the team leader or Ben Barczi
(805.550.72560). We are not looking for perfect people for our mission trips, but we do want to identify negative traits
that may be a detriment to our team in a successful ministry situation. Answering any question negatively will not
necessarily disqualify the applicant from the trip. It will show us the areas that may need working on in preparation for
the trip. Please do not answer questions simply yes or no, but give further explanation that you think might be helpful
to us.
Do you believe the applicant is ready for this trip (spiritually, emotionally, socially)?
Does the applicant respond positively to authority figures?
Does the applicant display spiritual fruit at home, work and school? What fruit do you see?
How does the applicant respond when he/she doesnt get his/her way?
Does the applicant display servant-like characteristics at home or in your relationship?
Does the applicant have personal devotions on a regular basis?
Your Name: __________________________________ Phone ___________________________
Signed: _______________________________________________ Date: _______________________
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Please give form to two leaders and/or someone who knows you well. If under 18, one should be from a parent/legal guardian.
Please return this form to: Missions Department First Baptist Church, SLO, 2075 Johnson Ave, San Luis Obispo, CA 93401.
SHORT TERM MISSIONS TEAM REFERENCE FORM
Applicant ________________________________ Your relationship to the applicant _____________
Thank you for taking the time to fill out this form. It is important that you be as candid as possible in your responses. If
you need more space, please use a separate piece of paper and write the applicants name at the top of that sheet. If you
would like to discuss an issue that might relate to a particular question, please call the team leader or Ben Barczi
(805.550.72560). We are not looking for perfect people for our mission trips, but we do want to identify negative traits
that may be a detriment to our team in a successful ministry situation. Answering any question negatively will not
necessarily disqualify the applicant from the trip. It will show us the areas that may need working on in preparation for
the trip. Please do not answer questions simply yes or no, but give further explanation that you think might be helpful
to us.
Do you believe the applicant is ready for this trip (spiritually, emotionally, socially)?
Does the applicant respond positively to authority figures?
Does the applicant display spiritual fruit at home, work and school? What fruit do you see?
How does the applicant respond when he/she doesnt get his/her way?
Does the applicant display servant-like characteristics at home or in your relationship?
Does the applicant have personal devotions on a regular basis?
Your Name: __________________________________ Phone ___________________________
Signed: _______________________________________________ Date: _______________________
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If you do not have a passport, we recommend that you begin the process immediately.
Complete passport information can be found on http://travel.state.gov/passport_services.html.
Most countries require that travelers passports not expire within six months of the end of
travel. Please check your passport immediately. If it is set to expire within six months at the
end of this trip, please begin the process to renew it now.
F. What about travel insurance?
Basic emergency medical evacuation/transportation; trip cancellation; lost baggage,
accidental death and dismemberment coverage is included in the team budget. Anything
outside of this list, you will need purchase your own overseas medical insurance or check your
current insurance to find out if you are covered. There are several insurance companies that
specialize in short-term missions travel coverage at very inexpensive rates, you can contact the
Missions Department for a list of options.
G. Is it acceptable to raise money through car washes, bake sales, rummage sales, etc.?
The key question to ask is, Would raising money in this way diminish the value of my short
term ministry in the eyes of my family and friends? In light of this possibility, we encourage
people to raise funds primarily through their prayer letters. Also, raising funds through prayerletters adds to your experience in what it would be like if you were a long-term missionary
having to raise funds. Lastly, we dont want to enable people to think giving to missions is only
worthy when receiving personal benefit.
H. Is financial support available from the church?
We have found 99% of the time, that if prayer letters are sent out on schedule and at least 50
copies are mailed, all the funds come in. At this time the Missions Department is not usually
able to provide financial support for short term missions trips; however, an application is
available from the Missions Director and each case will be considered prayerfully. In the event
that the Missions Department does agree to cover some amount of the trip, the maximum
support would be 10% of the total cost.
I. How critical are the financial deadlines?
The deadlines are vital. Usually the deadline is determined based on a major payment for
airlines, visas, housing accommodations, or vehicle rental deposits. Therefore, every effort
must be made to make payments on time. If, through unforeseen circumstances, this is not
possible, let your team leader know as soon as possible.
J. Is this trip tax deductible?
Yes, for each person who gives financial support to you, as long as the check is made out to
FBCSLO. The church will give receipts for donations at the end of the calendar year. Please
make sure your financial supporters are aware of this.
Your personal monies that you contribute are also deductible as a charitable donation (this
includes your trip deposit). However, in order for a contribution to be deductible, it must alsobe non-refundable. If you change your mind about participating on a team or something
arises that prevents you from going as planned, all monies given for you (both your personal
monies and monies contributed by your family/friends), are not refundable AND non-
transferable. Other personal trip-related expenses paid by participants may be deductible as a
charitable contributions. Be sure to consult IRS Publication 526 and/or your tax preparer for
more specific information.
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K. What is the proper way to explain to people how to give money to support me?
The explanation should contain the following information:
It should be above and beyond normal tithes and offering commitments they have made. The check must be made out to FBCSLO or First Baptist Church SLO. Contributions must not be included in the FBCSLO church offering. They must be mailed
into the office directly (2075 Johnson Ave, San Luis Obispo, CA 93401).
Funds that exceed your individual needs will go to assist others on your team. Excessfunds will not carry over for your participation on another FBC sponsored short term team
or a future short term or long term ministry with a mission agency.
Funds that exceed your teams need will go to assist other FBC-sponsored short-termteams.
Contributions are non-refundable. All funds must be in by the final deadline.
L. If I decide to cancel my involvement in the trip or the trip itself is canceled, can I get my
money back?
According FBCSLOs interpretation of the tax codes/laws, tax-deductible contributions are
non-refundable. These funds will however, stay in the Short Term Missions Fund to assist otherFBC-sponsored short term teams. If you cancel your involvement after travel documents are
purchased (airfare, visas, etc.) you will be expected to cover all of the fees, penalties, and loses
incurred at that point. If you have questions about this, feel free to contact Wayne Longcrier,
FBCs church treasurer at 805.543.0945. If the Missions Department cancels the trip, we will do
our best to refund all your money.
M. What if more money comes in for me than what I need?
Throughout this ministry you will function as part of a team. Your effectiveness is determined
not just from an individual standpoint, but also as a team. Also, each persons ability to raise
funds varies depending on who they know, how many people they know, their ability to
communicate effectively, etc. Therefore, since the goal is to fund the entire team, any monies
given beyond what you will need will go to support other team members who are strugglingwith their funds.
N. What if less money comes in for me?
Sometimes God uses a serious lack of support as an indicator that a person should not go on a
particular project. Our guideline is for you to have at least 50% of your support one month
before departure. If this does not occur, please discuss it with your team leader, and you will
be given the option of paying the difference or postponing your involvement. As previously
mentioned, any surplus funds raised by other team members will go to help support team
members who are under-supported.
O. Is it acceptable to pay your own way if you have sufficient funds?
Every aspect of our short term mission assignments is designed to encourage team membersin their relationship with God and to give them practical experience in what it is like to be a
missionary. This includes even how the project is funded! Even if team member (s) can afford
to pay for the entire trip themselves, they should cover no more than 50% of their own
support need and should send out prayer letters to raise the remaining 50%. If the other 50%
needed does not come in by one month prior to departure, participants are welcome to pay
the outstanding balance out of their personal finances. However, we want to emphasis that
one of the critical goals of these projects is to involve as many people as possible in world
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Dear Parent,
Please allow me to introduce myself. My name is Ben Barczi, and I serve as the missions director for
First Baptist Church of San Luis Obispo, and Vintage Community Church in Templeton. Together these
two separate campuses function as one church body.
Your child has expressed an interest in participating in one of our upcoming international short term
missions trips. Working with college students in our congregation for the past six years, I have
repeatedly seen the positive effect such international experiences have on students. I have also had
opportunity to talk with many parents who have had a lot of questions, as Im sure you do also.
FBCSLO and Vintage Community are local church bodies committed to seeing our congregations
grow in love with God, with His church and with His world. A major part of that purpose lies in helping
equip our members shine Gods love and goodness into the world around them, locally andinternationally. We want our members to grow in love for the world and concern for the well-being of
the needy; we have discovered that short term missions are one of the most effective ways to
accomplish this. Not only the team members themselves, but our church body at home who pray for
and support them gain from this international experience.
Moreover, short-term missions work proves deeply effective in changing the lives of people
worldwide, particularly when we partner with local churches and agencies who carry on the work
year-round. Your student will have the opportunity not only to help people in a foreign country, but to
meet and support those who have dedicated their lives to loving others in Gods name. Its our hope
that our short term missions teams will grow in their desire to support long term missionaries and
agencies.
We desire that you be informed about our short term missions trips and what they involve. Iparticularly want you, as a parent, to feel supported and included as your child pursues this
opportunity. Your comments will be an important factor in our consideration of your childs
participation.
Please take a moment to complete the form on the back of this letter indicating that you have
discussed this trip with your son or daughter. Should your child be accepted for a short term missions
trip, know that every effort will be made to ensure that the trip is a safe and positive one. We will also
include you on our email updates, both before, during and after the trip, so that youll know weve
safely arrived and hear what were doing!
If you have any further questions, please feel free to contact me at 805.550.7260, or at the church
office at 805.543.0945. I appreciate your willingness to consider your childs desire to be a part of this
mission trip.
In Christ,
Ben Barczi
Missions Director
First Baptist Church, SLO
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Short Term Missions Parent/Guardian Advice FormFirst Baptist Church, SLO Vintage Community Church 805.543.0945
Please fll out the ollowing legibly in ink. I you have any questions, contact Ben Barczi at 805.550.7260.
Students Name
Parent Contact Information
Parent/Guardian Name(s) Relationship to Child
Email Home Phone Cell Phone
We have discussed our son/daughters plan to apply for a short term mission trip. We understand FBCSLO will seek to provide for his/her
safety and welfare. In addition we have discussed with him/her the risks that are always involved in international travel. We realize our son/
daughter is responsible for making his/her own decisions and that FBCSLO is simply giving him/her the opportunity to participate as a
volunteer.
Yes No
Parents Advice
We have encouraged our child to participate.
We are not opposed to our child going, but we have the following reservations:
We have advised our child not to go for the following reasons:
We would like to be contacted by the team leader or missions director for more information.
Parent/Guardian signature Date
Please return this form by mail to:Missions Director
First Baptist Church, SLO
2075 Johnson Ave
San Luis Obispo, CA 93401
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First Baptist Church SLO
Short Term Mission Trip
Release of Liability for Minors
In signing this form, I, ___________________________, the parent and/or legal guardian of _________________
(Team Members Name), agree not to hold First Baptist Church, its officers, employees, or other agents liable for
injury, loss, damage, or accident arising out of the churchs negligence or that negligence of its officers,
employees or other agents that I (and my minor children participating with me listed below) might encounter
while on one of its mission trips to ___________________________ (Location of Trip) from __________ (date) to
____________ (date).
I realize and acknowledge that my (and my minor childs/childrens) participation on a mission trip to a foreign
country includes many risks and possible dangers. I am well aware that my travel to a foreign country exposes
me to such risks as accidents, disease, war, political unrest, injury from construction projects, and other
calamities.
I hereby assume risks that might result from my travel to a foreign country, and I agree to hold First BaptistChurch, its officers, employees, or other agents blameless for liability concerning my personal health and well-
being arising out of First Baptist Churchs negligence, and liability for my personal property that might be lost,
damaged, or stolen while on a mission trip arising out of First Baptist Churchs negligence.
I also give permission for my child to travel with an assigned staff member from First Baptist Church outside the
United States of America, and give that person permission to administer medical care in the case of an
emergency. I understand that the leadership will make every reasonable attempt to contact me in such an
emergency, but that communication may not be immediately possible.
I have carefully read the foregoing and I understand that my signature herein holds First Baptist Church, its
officers, employees, or other agents harmless for liability for injury, damage, loss, accident, delay, or irregularity
in schedule arising out of the churchs negligence or the negligence of its officers, employees, or other agent.
Parent or Guardians Signature ______________________________________ Date _______________________
Minor Child Participating (under 18 years of age):
Name ______________________________________ Date of Birth ___________________________
Notarization
In the State of California in the county of San Luis Obispo, this instrument was signed, attested, and
acknowledged before me on _______________________ (Date) by ______________________________.
Notary Signature ________________________________ Date _____________________________