Mission Commitment & Consent Form

My Consent and Committment

Yes, I am committed to being on team and going to Bukit Karmel

First Name *

Tip: your first name here

Email Address *

Tip: best contact email address

Last Name *

Tip: your surname

Mobile Number *

Tip: best mobile number

My completed checklist

Please note that Immunisations and other precautions appropriate for travel is your responsibility. We advise you to seek the advice of your medical practitioner or one of the specialist travel immunisation clinics as soon as possible to allow sufficient time to complete a course of treatment.

What is the name of your travel insurer, and policy number? *

Tip: We will use this info in case of an emergency

Have you made three copies of your Passport, Travel Insurance Certificate & Flight Tickets? *

Tip: One copy with carryon, copy with checkin lugguage, copy at home with emergency contact.

Have you been advised about seeing your GP before travelling to Indonesia? *

Tip: This is your responsibility.

By registering, I agree to be on the team and work with the mission leadership and local leaders during my time on Mission.

For more information, please review the information online first .

A Facebook Group has been created to help quick communication and create a place to store information. Here we will post details for info sessions, updates, and important communcation.

Medical Consent

I authorise and consent that the Team leader in charge of the mission, where impracticable to communicate with me, make the best possible medical or surgical treatment decisions as may be deemed necessary. And I consent that they contact my emergency contact.

I authorise and give medical consent. *

Yes

Date of Birth *

Who is your private health insurer and what is your policy number? *

Tip: We will only use this information for any medical help assistance

Have you forwarded a copy of your Medicare Card to the Mission Coordinator? *

Tip: We will only use this information for any medical help assistance

First Aid Trained *

Tip: If you are first aid trained, what is the date of your training?

Any Allergies *

Tip: Are there any allergies we need to know about?

Home Address *

Home City *

Home Postcode *

Emergency Contact Details

Emergency Contact Person *

Tip: name of your emergency contact

Contact number *

Tip: mobile of emergency contact person

Contact Email *

Tip: email of your emergency contact person

Signed Agreement

Stirling Family Church is a caring and responsible organisation. The information gathered on this form will be kept in a confidential location by the Team Leader, who may make contact with you. This is done in order to allow the team leader to properly care for you and the team. The information on this form will not be used for any other purpose than the mission trip.

If you wish to access any personal information held about you or you wish to find out more about our privacy policy, please contact Stirling Family Church.

As a member of the missions team, I agree that as a guest in another country, I am understanding I need to be flexible and willing to adjust to the expectations of our hosts.

Therefore as a committed member of the team, I understand and accept the following:

I understand that there are risks and dangers in any overseas travel and I fully release the team leader, team members, my church, Bukit Karmel, or associated persons from any liability or claims for any personal sickness or injury, death, loss of property or financial responsibility arising from the trip.

Yes, I agree *

Yes

I will abstain from making derogatory comments or arguments regarding people, politics, sports, religion, race or traditions, and I will seek at all times to express a godly example in my behaviour and adopt a flexible, cooperative attitude in coping with unexpected changes to plans and requirements on the trip.

Yes, I agree *

Yes

I promise not to initiate or seek new romantic relationships with team members or locals during the trip.

Yes, I agree *

Yes

I will completely refrain from carrying any tobacco, alcohol or prohibited drugs.

Yes, I agree *

Yes

I accept the role and decisions of the team leader and local authority, and support the unity of decisions that need are made, and promise to love and serve the Lord for the sake of the mission.

Yes, I agree *

Yes

I will refrain from promising or giving gifts to local people. If I want to do this I will check it with the team leader whose decision I accept as final. The team leader will also check with the appropriate local persons making a decision.

I understand this because what I well intend may in fact cause conflict and jealousy and strife after you go.

Yes, I agree *

Yes

I agree to sign off on this form

Do you agree to forward the information in this form to the Team Leader? *

Tip: THis forms part of an electronic 'signature'.

Signed *

Tip: Instead of signing, I print my full name here.