Current 7th graders. July 20-24, Engage: Service with Christ In Youth to St. Louis, MO

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1 One of the core values for the Student Ministry at Christ s Church, is to teach our students what it means to provide service to the hurting, broken, and lost, so the name of Jesus will be made known and famous! To get out of our normal environment to see what God is doing in other parts of the world, will make a huge impact on our personal relationship with Jesus, and will help us see how we can be more like Jesus and make His name know and famous in our own community. Current 7th graders July 20-24, 2015 Engage: Service with Christ In Youth to St. Louis, MO $300 This includes, transportation, lodging, meals and fun activities while we are on-site, plus all service project supplies. This does not include meals on the way there or spending money. Do? Be? Go Be? What do those words mean? What does that have to do with Engage? They reference those parts of the program that put our values into action. Engage: Service trains you to engage people by doing good works. It connects you to people in the community through partnerships with churches, ministries, and organizations, teaching you how to put Kingdom work into action. You get to use your hands, minds, and hearts to DO Kingdom work and encourage others through service. These weeks are not the only opportunities to connect to and partner with Kingdom workers, though. Actually, the opportunities go beyond a week, beyond the summertime, beyond even the United States. We will partner with Mission St. Louis PRAY, PRAY, PRAY, then PRAY, after that PRAY, follow that with PRAY- ER. Pray that God will provide the faith, trust, clarity, resources, safety, and passion a trip like this requires. 2. Talk honestly with loved ones who will help you make the decision. 3. Complete your application. 4. Contact us with questions, concerns, etc. Call or us at: or sara.hill@ccochurch.com

2 TENTATIVE SCHEDULE Monday 8:30a church to leave 12:30p Arrive in STL & eat 2p Check In & get settled 5:30p Dinner 7p Welcome & Leader Meeting 8p Connection: Each night all the groups at Engage come together for a time of worship with singing, teaching, games, and videos. 9p Download: After Connection, your group has a chance to meet together and talk about the day. This is where students share what God is doing and discuss how they can take their learning home. 10p In dorms Tuesday-Thursday 7a Breakfast 8a Search the Scriptures 8:30a Leave Campus to Serve (lunch on site) 3:30p Cleanup/Head to campus 5:30p Dinner 7p Connection 8:30p Download 10p In dorms Friday 9a 2p Cleanup, Breakfast, Check out Arrive back at the church

3 Eligibility 1. Must be pursuing a relationship with Jesus Christ. 2. All current 7th graders. 3. Must have a servant s heart, interested in missions work and open to God s calling in their lives. 4. Must be physically able to tolerate rugged conditions and participate in work related projects. 5. Must be of good character, above reproach, and in good standing with the Student Ministry at Christ s Church of Oronogo 6. Must fill out and turn in all required application forms, fees, references, etc. on time. Requirements Complete this Application Form with Parental Consent Complete the CCO Medical Release Form Complete the CIY Medical Form Provide the $50 application/non-refundable deposit fee Provide us with 2 written references (See Below) Complete a 1-2 page typed, essay and tell us why you want to go on this mission trip. Once you are accepted: Attend the required pre-trip meetings Make final payment on time July 12, References Enclosed are two reference forms to be given to your references. Have each of your references complete their form and return it to you. Your application cannot be processed until we receive both of your references. You must have 1 reference from a school teacher or employer And you must have 1 reference from a d-group leader, mentor or youth minister. When you have completed the first 6 requirements listed above, put them all together in the Registration Drop Box in the Student Ministry Center

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7 Christ s Church of Oronogo Student Ministry PERSONAL INFORMATION: Participant s Name: Today s Date: / / Address: City Zip: Home Phone: ( ) Date of Birth: / / M or F Current Grade: PARENTAL/GUARDIAN CONSENT: As the parent or legal guardian of the above named minor, I give my permission for him or her to participate in activities, events, and programs of Christ s Church of Oronogo during the year September 1, 2014, through August 31, I understand the inherent risks that are involved in these activities and hereby release CCO, its staff, employees and volunteers from responsibility and liability for any injury or illness sustained during these activities, events, and programs. Further, I do authorize the minister, adult leader, or sponsor of the activity, event, or program, or any CCO staff member, in the event I cannot be reached by phone, to give consent to a physician and or hospital for emergency medical or surgical treatment. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment. Further, I authorize Christ s Church of Oronogo to use photographs and video footage of the participant for promotional materials. Printed Name of Parent/Guardian: Signature of Parent/Guardian: Date: MEDICAL INFORMATION: Medical Insurance Company: Primary Name Insured on Policy: Policy Number: Group Number: Physician: Physician s Phone Number: ( ) Emergency Contact Parent/Guardian: Cell Phone: ( ) Work Phone: ( ) Secondary Emergency Contact Person: Home Participant s Phone: ( ) Name: Cell Phone: ( ) Work Phone: ( ) PLEASE FLIP OVER AND FILL OUT THE BACKSIDE OF FORM.

8 CONFIDENTIAL MEDICAL HISTORY Participant s Name: Do you regularly have or have had any of the following symptoms or conditions? Yes No 1. High blood pressure 2. Heart disease 3. Heart Murmur 4. Irregular heartbeat 5. Tuberculosis 6. Hepatitis 7. Seizure disorder 8. Bleeding disorder 9. Anemia 10. Blood disorder 11. Asthma 12. Diabetes 13. Hypoglycemia 14. Anorexia/Bulimia 15. Skin problems 16. Hot/Cold intol. 17. Circulation prob. Yes No 18. Knee/ankle prob. 19. Neck/back prob. 20. Leg/foot prob. 21. Headaches 22. Head injury 23. Jaundice 24. Heatstroke 25. Bladder/kidney prob. 26. Thyroid prob. 27. Endocrine disorder 28. Hearing impairment 29. Vision impairment 30. Motion Sickness 31. Sleep walking 32. Currently pregnant 33. Special diet 34. Learning disability Yes No 35. Medical/Equip. device 36. Stomach Ulcers 37. Intestinal prob. 38. Active bedwetting 39. Chest pain/pressure 40. Heart palpitations 41. Unexplained sweating 42. Freq. dizziness/fainting 43. Freq. Shortness of breath 44. Heart burn 45. Muscle cramps 46. PMS or menstrual prob. 47. Broken bones 48. Arm/shoulder prob. 49. Genetic disorders 50. Cancer Please explain any yes responses (with item number): ALLERGIES (Drugs, food and environment with description of reaction): CURRENT MEDICINES TAKEN (Prescription and over-the-counter): DRUG DOSE Time Taken SPECIAL CONSIDERATIONS & INFORMATION:

9 References Are Due Wednesday April 1, 2015 is being considered to participate in a summer missions experience. We appreciate your willingness to help us understand this applicant and his/her strengths and weaknesses. It will be most helpful to the applicant and us if you would be completely honest and open. 1. How long have you known this person? 2. In what capacity do you know this person? Home Church Elder or Minister Core Class Teacher Youth Leader School Teacher Employer Sports Coach 3. What, in your opinion, are the major strengths of this person Positive Attitude Hard Worker Sense of Humor Cooperative Easy Going Organized Patient Generous Leader Compassionate Gets along well with others Creative Interacts well with adults Friendly Interacts well with small children Other (please be specific) 4. What areas of weakness or need for growth do you perceive in the applicant? Immature for his/her age Easily Angered Lazy Impatient Negative Attitude Self-Centered Unfriendly Moody Unwilling to follow directions Argumentative Complains when asked to do Other something (please be specific) 5. How do you describe the applicant s character? Teachable Servanthood Respects authority Strong Work Ethic Takes Initiative Please turn over and complete the back side

10 6. To what extent would you consider him/her grounded in his/her Christian beliefs and knowledge of the Bible? Weak Mediocre Strong 7. How does the applicant s mental & emotional maturity correlate with his/her biological age? Not at all Close Completely 8. Please circle any problems the applicant may have in the following health areas: Hygiene Ability to engage in rigorous activities Drugs or medications Chronic health problems 9. Do you see this student as a potential leader? If so, how? 10. Do you believe this applicant has a heart for missions work? If so, how? Other comments: Thank you so much for your time and thought in completing this reference. Please return this form to the applicant in an envelope no later than Wednesday April 1, Reference s Name: Address: City: State: Zip: Cell:

11 References Are Due Wednesday April 1, 2015 is being considered to participate in a summer missions experience. We appreciate your willingness to help us understand this applicant and his/her strengths and weaknesses. It will be most helpful to the applicant and us if you would be completely honest and open. 1. How long have you known this person? 2. In what capacity do you know this person? Home Church Elder or Minister Core Class Teacher Youth Leader School Teacher Employer Sports Coach 3. What, in your opinion, are the major strengths of this person Positive Attitude Hard Worker Sense of Humor Cooperative Easy Going Organized Patient Generous Leader Compassionate Gets along well with others Creative Interacts well with adults Friendly Interacts well with small children Other (please be specific) 4. What areas of weakness or need for growth do you perceive in the applicant? Immature for his/her age Easily Angered Lazy Impatient Negative Attitude Self-Centered Unfriendly Moody Unwilling to follow directions Argumentative Complains when asked to do Other something (please be specific) 5. How do you describe the applicant s character? Teachable Servanthood Respects authority Strong Work Ethic Takes Initiative Please turn over and complete the back side

12 6. To what extent would you consider him/her grounded in his/her Christian beliefs and knowledge of the Bible? Weak Mediocre Strong 7. How does the applicant s mental & emotional maturity correlate with his/her biological age? Not at all Close Completely 8. Please circle any problems the applicant may have in the following health areas: Hygiene Ability to engage in rigorous activities Drugs or medications Chronic health problems 9. Do you see this student as a potential leader? If so, how? 10. Do you believe this applicant has a heart for missions work? If so, how? Other comments: Thank you so much for your time and thought in completing this reference. Please return this form to the applicant in an envelope no later than Wednesday April 1, Reference s Name: Address: City: State: Zip: Cell: