Peru Application

Peru Trip Application

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Last Name

Gender

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Address

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State

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Occupation

Full name as it appears on your PASSPORT (if different than above}:

Address on PASSPORT

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State

Zip Code

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Passport Country of Issue (Country Code on passport - if you do not currently have a passport write N/A)

Passport Number (If you do not currently have a passport write N/A)

Passport Expiration Date

Relationship to Emergency Contact Person*

Emergency Contact Name (do not include anyone traveling with you)*

Emergency Contact Phone Number*

Are you married?

If yes, what is your spouse's name?

If you are married does your spouse support your participation?

Please upload a recent picture of yourself

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Do you have any known allergies to food, medicine, etc.?*

If yes to allergies, please describe:

Have you ever been treated for a medical/emotional condition?

If yes to emotional/mental condition, please describe (If no, use N/A):

Please list any condition or physical disability that may limit your participation (If none, use N/A):

Please list any current medications (If none, use N/A):

It is highly recommended that you carry or obtain primary medical insurance to cover possible additional medical needs that may arise during international travel. Do you have primary medical insurance?

What is the name of your insurance carrier?

Are you part of a church or ministry? If so, which one? If not, type no:

Please give the name and contact details (phone and email) of a personal reference who is a pastor or Christian ministry leader who would recommend you for this trip.

Have you been referred by a previous Pour It Out team member or student? If YES, please list who:

Have you been referred by someone else? (Pastor, leader, friend, etc) If YES, please list who:

Are you currently a senior pastor or senior leader?

Do you attend regularly?

How long have you attended?

In what areas of your church are you currently serving in or have you served in the past?*

What gifts of the Spirit do you believe you operate in?

Have you received any training in the area of healing?

If you have received training in the area of healing, please describe.

I understand that serving on this mission trip requires following leadership direction, adhering to ministry guidelines, and maintaining Biblical principles of conflict resolution (Matthew 18:15-20). Please indicate below if you agree to these requirements and commit to being a cooperative team member.

Are you fluent in English?

What is your primary language (if other than English)?

Are you fluent in any other languages? If so, please list them.

Please tell us why you are applying for the Pour It Out Peru trip :

Please briefly describe your Christian journey:

Please briefly describe any Christian ministry experience you have had (if any):

Is there anything you think we should know about you?

Please state ways you have connected with Ben & Jodie Hughes and Pour It Out Ministries:

Any other comments you would like to add?

I hereby declare the following: • I am 18 years of age or older. (If not yet 18, both youth and parents must sign) • I acknowledge that international travel involves danger and risk. I acknowledge that the dangers and risks include, but are not limited to, the hazards of travel by air, boat, raft, jeep, automobile, bus, taxi, bicycle, and on foot, travel in foreign countries, in jungles, mountains, high altitudes, steep terrain; travel and/or attendance at meetings among possibly unfriendly persons; sickness or injury in areas where medical assistance may be primitive or inadequate, unavailable or not readily available, and/or where rapid evacuation is not available; or where there is exposure to crime, to civil unrest and to forces of nature or other dangers. I understand that the above and/or other possibilities are risks in ministry/missions travel. • I acknowledge that Pour It Out Ministries, pastors, leadership, or members do not accept any responsibility for injury, illness or loss suffered by me, and that all medical or personal expenses in connection with or made necessary by my illness or injury on this trip are my own responsibility. • I acknowledge that Pour It Out Ministries does not carry any insurance on my behalf, and I acknowledge that Pour It Out Ministries has requested that I carry or obtain primary medical insurance and that I am required to obtain traveler's insurance to cover possible additional medical needs, especially related to previously existing medical conditions. • I hereby assume all risk of personal injury, sickness, or death, and damage to or loss of my personal property, and any delay, change or cancellation of travel arrangements, and any and all other damage or expenses I may suffer as a result of participation in this ministry/mission trip or in activities related to it. I agree to be fully responsible for my actions. Should I become ill or injured or suffer other damage, I will pay all costs involved including costs of evacuation and medical care I might receive. • I accept and assume all risks and hazards from this activity, both known and unknown, including but not limited to the risks and hazards previously indicated. • I hereby voluntarily release, forever discharge, and agree to hold harmless and indemnify Pour It Out Ministries, its directors, officers, agents, employees, coordinators, facilitators, volunteers, and other team members from any and all liability, claims, demands, actions or rights of actions, which are related to, arise out of, or are in any way connected with my participation in this activity, which I now have or may have in the future, specifically including but not limited to the negligent acts of omissions of any person so released, held harmless and indemnified, and specifically including claims relating to any personal injury that I may suffer. • I agree not to make a claim, file suit, or demand anything from any injury, death or loss that arises from my participation in this activity. • I agree to pay the costs and/or legal expenses incurred by the trip leader(s), organizers, and/or participants as a result of any claim or suit filed by me or filed by anyone else as a result of my conduct. • I consent and agree to pay for any medical treatment rendered to me by anyone for any injury or other medical situation during, or resulting from, my participation. • I authorize Pour It Out Ministries to arrange transportation where it applies, food, and lodging for me on this trip. Unless previous arrangements have been made by my team leader(s), I acknowledge that I am responsible for securing my own air transportation to and from this trip. • I agree that these promises, agreements, assumptions of risk and releases bind me, my family, all minors with me or on whose behalf I sign, and my heirs or legal representatives and assigns.

Yes

I understand and agree that all fees paid are non-refundable, regardless of cancellation, withdrawal, or changes in travel plans for any reason.

Yes

Thank you for applying for the Pour It Out Ministries trip to Peru!
Every application is prayerfully considered before the Lord and numbers are strictly limited.
We look forward to hearing from you!

PERU APPLICATION

Thank you for applying for the Pour It Out Ministries trip to Peru! Every application is prayerfully considered before the Lord and numbers are strictly limited. We look forward to hearing from you!

Thank you for applying for the Pour It Out Ministries trip to Peru!
Every application is prayerfully considered before the Lord and numbers are strictly limited.
We look forward to hearing from you!