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MISSION TEAM APPLICATION Ingleside Baptist Church

834 Wimbish Road Macon, GA 31210

478.477.7251 fax 478.477.7256 www.ingleside.org

PERSONAL INF ORMATION

Legal Name (as on passport): ____________________________________ Date: ____________________

Address: ______________________________________________________________________________

City: _______________________ State: ______________________ Zip Code: _____________________

Home: _____________________ Work: ______________________ Cell: _________________________

Place of Employment: ___________________________________________________________________

Job Title: ___________________ Email: __________________________________ T-Shirt Size: _______

Date of Birth: ____________________________ Social Security Number: _________________________

Citizenship: ______________________________ Country of Birth: _______________________________

Please enclose a copy of your passport.

Frequent Flyer Program and Number: _______________________________________________________

__ Male __ Female Marital Status (please check one): __Single __Married

Spouse’s Name: _________________________________________________________________________

Names of Children: _______________________________________________________________________

EMERGENCY CONTACT/BENEFICIARY INFORMATION

Name: __________________________________ Relationship: ___________________________________

Address: _______________________________________________________________________________

City: _______________________ State: ______________________ Zip Code: _____________________

Home: _____________________ Work: ______________________ Cell: _________________________

Email: ________________________________________________________________________________

Is your emergency contact also your beneficiary? Y N If not, who? _____________________________

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MISSIONS EXPERIENCE

Location Mission Organization Dates Ministry

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

CHURCH INVOLVEMENT

Are you a member of Ingleside Baptist Church? Y N

If not, where are you a member? _________________________________________________________

How long have you been a member? _____________________________________________________

What ministries have you been involved with at church? Please include time of involvement and any

leadership positions held.

COMMUNITY INVOLVEMENT

Location Organization Date Ministry/Tasks

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

_______________________________________________________________________________________

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Name: __________________________________ Relationship: ___________________________________

Address: _______________________________________________________________________________

City: _______________________ State: ______________________ Zip Code: _____________________

Home: _____________________ Work: ______________________ Cell: _________________________

Email: ________________________________________________________________________________

Name: __________________________________ Relationship: ___________________________________

Address: _______________________________________________________________________________

City: _______________________ State: ______________________ Zip Code: _____________________

Home: _____________________ Work: ______________________ Cell: _________________________

Email: ________________________________________________________________________________

REFERENCES Please provide three refere nces. One reference should be a church pastor or department director in a

ministry in which you serve or have served. The other references should be people who know your

ministry abilities as well as your strengths and weaknesses. No family members should be listed.

Name: __________________________________ Relationship: ___________________________________

Address: _______________________________________________________________________________

City: _______________________ State: ______________________ Zip Code: _____________________

Home: _____________________ Work: ______________________ Cell: _________________________

Email: ________________________________________________________________________________

OFFICE USE ONLY

� References Contacted Date: ___________________ Notes: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

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SALVATION TESTIMONY

In the space provided, please share your salvation testimony. Include how and when you repented of your sin

and initially trusted Jesus Christ as Lord and Savior of your life. Also, describe your walk with the Lord at the

present time.

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S.H.A.P.E. FOR SERVICE

S.H.A.P.E. stands for spiritual gifts, heart, abilities, personality, and experiences. God has uniquely made you

for His glory. How might you be used on a mission team? Check all that apply.

*If you would like to better understand the gifts God has given you, take time to complete this survey.

https://www.lifeway.com/lwc/files/lwcF_PDF_Discover_Your_Spiritual_Gifts.pdf

Spiritual Gifting:

� Administration

� Discernment

� Evangelism

� Exhortation

� Giving

� Hospitality

� Leadership

� Mercy

� Service

� Teaching

� Other _________

Heart/Interests:

� Agriculture

� Business � Children’s Ministry � Community

Development � Construction � Church/Leadership

Development � Communications/Media

Ministry � Creative Arts

� Cultural Exchange � Deaf Ministry � Disaster Relief � ESL/EFL/English � Education � Evangelism � Ethnographic Research

� Human Needs Ministry � Information

Technology/Computer

Support

� Literature Distribution

� Medical Ministry � Prayerwalking

� Sports/Recreation � University Ministry

� Vision/Discovery � Youth Ministry

� Other: ____________

Abilities:

Experiences/Special Training/Courses/Foreign Languages:

Anything else you would like to share about how God has shaped you:

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TEAM EXPECTATIONS

The following statements represent attitudes and behaviors that will contribute to a successful, God-honoring

mission trip:

1. Be prayerful, in the word, and dependent on the leadership of the Holy Spirit.

2. Be in attendance at all preparation and training meetings prior to the trip.

3. Be conscientious to serve with excellence, and have a “whatever it takes” attitude.

4. Be humble, and have a servant’s heart toward nationals, missionaries, and teammates.

5. Be positive in my conversations and actions and open to other people’s methods and ideas.

6. Be submissive to the authority of my team leader and host missionaries.

7. Be inclusive in all relationships without communicating a romantic interest while on a trip.

8. Be respectful of the culture in which I serve.

9. Be thankful for the privilege of serving.

10. Be willing to abstain from the use of alcohol, tobacco, or any other behavior that may be considered

disruptive to the purpose of the trip. I understand that these behaviors are grounds for dismissal from

any volunteer project, and I will return home at my own expense.

I have read and affirm these attitudes.

Signature: ______________________________________________ Date: _____________________________

Printed Name: __________________________________________

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INTERNATIONAL MISSION TRIP RELEASE

I, _________________, desire to visit foreign countries with Ingleside Baptist Church and participate in

mission trips organized by the church. I release and forever discharge Ingleside Baptist Church, my church, and

any other ministry/organization involved and each of the respective members, employees, officers, directors,

and representatives from any and all claims for any and all injuries, illnesses, losses, or damages I might have

on or in any way relating to such mission trips, including without limitation, those relating to me leaving the

United States of America and visiting foreign countries, including my stay in any such foreign country and my

trip from any such country.

I further understand that such mission trips may expose me to unique hazards such as disease, dangerous

environment and hostiles that might lead to serious illness, bodily injury, or death. I release and forever

discharge Ingleside Baptist Church, my church, and any other ministry/organization involved and each of their

respective members, employees, officers, directors, and representatives from any and all claims, including

claims of negligence or gross negligence, for any and all injuries, illness, losses, or damages I might have on or

in any way relating to such mission trips.

I am eighteen (18) years of age or older, and the RELEASE is binding on me and my executor, administrators,

and heirs.

I give Ingleside Baptist Church and its representatives with me on any such mission trip authority to request

and authorize medical and/or hospital treatment for my benefit in the event of an injury or sickness sustained

by me while on such mission trips, including, without limitation, while traveling to and from any foreign

country. I agree to pay for all such treatment and to reimburse Ingleside Baptist Church for all costs and

expenses incurred by it with respect to such treatment.

I have fully read the above and understand it.

Signature: _________________________________________________ Date: __________________________

Printed Name: _____________________________________________

ACKNOWLEDGEMENT

STATE OF: _________________________________________________________________________________ COUNTY OF: _______________________________________________________________________________

The foregoing RELEASE was acknowledged before me this _____ day of ________, 20____.

__________ personally appeared before me, whose identity I proved on the basis of ____________________.

(Notary Seal) Notary Public: _____________________ My commission expires: __________

(in the presence of a notary)

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HEALTH INFORMATION

Name: _____________________________________________ Date: ______________________________

Do you have any particular health problems, diseases, or physical limitations? If yes, please describe:

Have you had any serious illnesses in the last five years or been under the ongoing care of a doctor in the last year? If yes, please describe:

Do you have any chronic allergies? If yes, please describe:

Are you allergic to any medications? If yes, please list medication allergies:

Please list ALL medications you take on a regular basis, including dosages and frequency:

Do you have health insurance? Company: ______________________________________________________________________________ Policy Number: __________________________________________________________________________

Note: You will be asked to periodically update this information.

8024041v1

NOTICE - BACKGROUND INVESTIGATION (VOLUNTEER APPLICATION)

In connection with your application to serve as a volunteer with Ingleside Baptist Church (the

“Company”), notice is hereby given that a consumer report and/or investigative consumer report may

be obtained from a consumer reporting agency for verification purposes. These reports may contain

information about your character, general reputation, personal characteristics and mode of living,

whichever are applicable. They may involve personal interviews with sources such as your neighbors,

friends or associates. The reports may also contain information about you relating to your criminal

history and/or include a criminal background check, social security number verification, driving and/or

motor vehicle records, or other background checks.

You have the right, upon written request made within a reasonable time after the receipt of this notice,

to request disclosure of the nature and scope of any investigative consumer report prepared by contacting

the Company and Protect My Ministry, 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618;

Phone: 1-800-319-5581. For information about Protect My Ministry’s privacy practices, see

www.protectmyministry.com. The scope of this notice and below authorization is not limited to the

present and will continue throughout the course of your volunteer service and allow the Company to

conduct future screenings, as permitted by law and unless revoked by you in writing.

ACKNOWLEDGEMENT AND AUTHORIZATION

By signing below, I hereby authorize the obtaining of a criminal background check by the Company at

any time after receipt of this authorization and throughout the course of my volunteer service.

Signature: ___________________________________ Date: _____________________________ (Must be within the last 30 days)

Print Name: __________________________________ SSN*: ____________________________

Driver’s License No.: __________________________ D.L. State Issued: ___________________

Home Address: _____________________________________________________________________

City: _____________________ County: ___________ State: _____________ Zip: ___________

Applicant’s Email Address: ___________________________________________________________

For identification purposes only, please provide your complete Date of Birth: ____________________

*Please note: a search without a full Social Security Number (SSN) will be processed by name and date

of birth only, which will lower the accuracy and quality of the results returned.