Puerto Rico Missions Trip Application Puerto Rico Partnership: Led by Dr. Rafael Maldonado Jr. (Ray) P. O. Box 7079, Lakeland, Fl. 33807 386-457-0645 Mission trip dates: February 27 thru March 6, 2018 This application and initial payment must be filled out completely and submitted to Ray Maldonado by November 1, 2017 in order to be considered for participation in the trip. NAME: ADDRESS: male/female (circle one) DOB: TELEPHONE: EMAIL: Please describe briefly how you came to Christ and any significant growth seasons in your Christian life: (Use separate sheets as desired) Describe your personal devotional life: Are you a member of the Vineyard Church? participation in the church? If yes, how long and what has been your Please share the reasons you believe God is calling you to be involved with this trip. Describe any past mission s experience you have: In what ways has God used you in peoples lives? Have you led anyone to trust Jesus Christ as Savior? Describe any fears you have that might surface on a cross cultural mission trip:
Share your spiritual gifts and how you could be an asset on the short-term team (Socially, spiritually, skills and talents): Please evaluate yourself according to the following criteria: Quality Weak Strong 1 Serving 1 2 3 4 5 2 Social Sensitivity 1 2 3 4 5 3 Energy Level 1 2 3 4 5 4 Teachable 1 2 3 4 5 5 Flexible 1 2 3 4 5 6 Healthy 1 2 3 4 5 7 Communication Skills 1 2 3 4 5 8 Adventuresome 1 2 3 4 5 9 Response to Authority 1 2 3 4 5 10 Coping Skills 1 2 3 4 5 11 Dependable 1 2 3 4 5 Describe any health concerns that the team leaders should be aware of. Please include comments which also include: personal sleep requirements, ability to handle fatigue, need for personal space and solitude, allergies, ongoing medical concerns, current medications, heat and sun sensitivity, food sensitivities, areas of physical or emotional limitation: Two character references: Name: Context in which they know you: Address: Telephone: Email: Name: Context in which they know you: Address: Telephone: Email: Share anything else you would like us to know about you, e.g. ever been to Puerto Rico?
The cost for the trip will be $1,175.00. It may be raised slightly, depending on airfare costs. The trip will include airfare, housing, meals, and transportation in Puerto Rico. The dates for payment are as follows: November 1, 2017 $375* This is a non-refundable amount. We will purchase your airline ticket right away. If you cannot attend, for any reason, you will have your airline ticket to use for a year. December 15, 2017 $400 February 1, 2017 $400 Total $1,175 Please make checks or money orders to: Iglesia La Viña In memo sec. please write:missions trip February 27-March 6, 2018 Send application and payments to: Dr. Rafael Maldonado Jr. P.O. Box 7079, Lakeland, Fl. 33807 The trip will be led by Dr. Rafael Maldonado Jr. (Ray) Tentative ministry team meetings are Sundays 6:00 PM thru Zoom teleconferencing through a computer equipped with a camera. Please allow for a two hour meeting period. These meetings are mandatory for team members. November 5, 2017 December 3, 2017 January 7, 2018 February 11, 2017
Puerto Rico Partnership Missions Short-Term Missions Trip Liability Release Agreement I, (participant) acknowledge that I desire to participate in the following Puerto Rico Partnership Missions trip (hereinafter the Activity ): Aguadilla, Mayaguez and San Juan, Puerto Rico (trip locations) to be conducted approximately on or between: February 27 thru March 6, 2018. The Puerto Rico Partnership and the undersigned agree that my participation in the Activity poses risks including but not necessarily limited to: sickness and/or health hazards due to poor food and water, diseases, pests, and poor sanitation, personal injury, death, crime, political instability, government opposition to the Activity, and inadequate medical facilities as well as similar and dissimilar risks (herein Risks ). My participation in any and all activities is voluntary and I agree to accept the risks of my participation, including all risk of personal injury or death. In consideration of the Puerto Rico Partnership permitting me to participate in the Activity and all its related activities and to use La Viña and Vineyard facilities and equipment, on behalf of myself and my personal representatives and their successors in interest (all hereinafter referred to as releasers ), I do hereby release the Puerto Rico Partnership and La Viña de Mayaguez, its officers, directors, employees, representatives and agents (hereinafter referred to as releases ) from any and all liability for any loss, cost, expense or damage and any claim for damages thereafter, on account of injury to my person or property or death, whether caused by the negligence or releases or otherwise, while I am participating in any way in or preparing for the Activity. I further agree to indemnify, defend and hold harmless releases and each of them from all loss, liability, damage, expense or cost which any of the releases may suffer or incur due to or in any way arising out of my participation therein and related activities, whether caused by the active or passive negligence of any of the releases or otherwise. Medical insurance [please check box(s) below that apply]: I understand I DO have the following medical and/or accident insurance policy(s) and I agree that I am responsible to submit and process any claims for coverage and/or reimbursement subject to the insurance company s policies and to pay any and all medical and/or dental expenses directly or indirectly related to my participation in the Activity which are not covered under the policy terms. I understand that the Puerto Rico Partnership has no responsibility for premiums, coverage or claims there under. Name of company Policy No. I DO NOT have medical or accident insurance, and I agree to pay any and all medical and/or dental expenses directly or indirectly related to my participation in the Activity, including during the transportation to and from the Activity. I understand that the Puerto Rico Partnership has no responsibility for any medical and/or dental expenses I may incur. Short Term Missions Liability Agreement 1 of 2 total pages Ver. 1.04 / 08.08.15
I do hereby authorize the Puerto Rico Partnership or its representative(s), team leader(s), team member(s), supervisor(s) and vehicle driver(s), in case of medical emergency, to give consent to a physician and/or hospital for emergency medical, surgical or dental examination and/or treatment while on this trip. FOR MINORS ONLY: Parental Consent for medical treatment of a minor participant I, (print name) the parent/legal guardian of the participant, who is a minor, I do hereby authorize the Puerto Rico Partnership or its representative(s), team leader(s), team member(s), supervisor(s) and vehicle driver(s), in case of medical emergency, to give consent to a physician and/or hospital for emergency medical, surgical or dental examination and/or treatment while on this trip. If there is an emergency please use best efforts to contact me at: (Phone). If there is an emergency and I cannot be reached please contact: Name: Relationship: Address: Phone: City: State: WHO IS AUTHORIZED IN MY BEHALF Zip: Signature of Guardian/Parent I agree that in the event my conduct is considered by the Puerto Rico Partnership or its representatives to be so unsatisfactory that it jeopardizes the safety and/or success of the Activity, and that mediation during the Activity has failed to correct my conduct, that my services in connection with this Activity shall end and I may be required to return home before completion of the Activity, possibly at my own expense. I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Georgia and Puerto Rico and that, if any portion of the agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Any portion of this agreement that is held invalid for any reason shall be enforced to the fullest extent permitted by applicable law I have carefully read the above release and I know its contents. I am aware that this is a release of liability and I sign this voluntarily. To the extent that I am a minor, my parent or legal guardian s signature below indicates that my parent or legal guardian hereby expressly gives to the Puerto Rico Partnership and the other releasers the same releases, consents and indemnities set forth herein. I hereby release the Puerto Rico Partnership and its representatives (including all releases as defined above) from any claim whatsoever on account of first aid, treatment or service rendered to me during participation in the Activity. This release contains the entire agreement between the parties relating to the subject matter. The terms of this release are contractual and not a mere recital. READ BEFORE SIGNING Print Name of Participant Signature of Participant Date SIGNATURE OF PARENT OR GUARDIAN (IF PARTICIPANT IS A MINOR) CONSENTING TO A MINOR S PARTICIPATION UNDER THE FOREGOING TERMS AND CONDITIONS: Print Name of Guardian/Parent Signature of Guardian/Parent Date Short Term Missions Liability Agreement 2 of 2 total pages Ver. 1.04 / 08.08.15