Team Registration Form - LightShine Ministries Alaska

If you are a RETURNING TEAM MEMBER <<< click on this printable link and mail completed form to our address below.

ALL NEW TEAM MEMBERS need to fill out a Printable Registration Form and send it in to us with a $40 registration fee (which is non-refundable and non-transferrable). It will be used for purchasing your team shirt and other administrative expenses in planning your team.

Mail completed forms to the address below with a personal check.

LightShine Ministries P.O. Box 777 Mount Joy, PA 17552

NEW TEAM MEMBERS may also fill out the Online Registration Form (on this page) and hit “Submit” at the bottom.

Instructions: Answer all questions below and after you hit "Submit", your completed form will be sent to us. We consider this information to be very important in helping make this missions trip a success for you!
Name of Team Assignment:*
Team Date*
MM slash DD slash YYYY
Your Email Address*
Legal Name*
First Middle Last
NOTE: Your legal name (above) should be as it appears on your Drivers License - (VERY IMPORTANT for your airline ticket)
Permanent Address*
Street, Box #, or R.R. City State / Province ZIP / Postal Code Country
Primary Phone*
Secondary Phone
Fax
Age*
Birthdate*
MM slash DD slash YYYY
Gender*
- Male
- Female
Occupation
How did you hear about LightShine Ministries?
Please list a character reference whom we may contact*
First Last
(pastor/leader/etc.)
Relationship*
Phone*
Email*
Address*
Street, Box #, or R.R. City State/Province ZIP / Postal Code Country
Please describe your relationship with Jesus Christ*
Please describe your personal goals in being part of this team*
(Why are you going?)
Have you had previous experience on the mission field or traveled in a foreign country?*
- Yes
- No
If yes, Please list countries and experience
What talents or skills do you have that the Lord can use on your outreach?
(e.g. carpenter, electrician, plumber, auto mechanic, pastor, teacher, music, drama, outdoor survival skills, etc.)
Please describe your health, including any physical, mental or dietary limitations that you think we should know about.
This information will be held in strict confidence between you and your team leader. Their desire is for you to have the best experience possible on your team assignment.
Are you on regular medication or currently under a doctor’s care?*
- Yes
- No
Your safety and comfort is very important to us.
If yes, please explain
List any allergies
(food, medicine, environment, insect) NOTE: Your team leader should know these things for your own safety and comfort. They will be planning food menus and it is important to communicate with them before and throughout your team assignment.
Date of last Tetanus Shot
MM slash DD slash YYYY
Check All That Apply
- Diabetes
- Asthma
- Physical disability
- Heart Trouble
- Epilepsy
- High blood pressure
- Pregnant
- Bee/wasp reaction
- Fainting
Do you understand that in order to participate on this work team you must be in good physical condition and able to work a 40 hour week in Alaska?*
- Yes
- No
Any Questions?*
Are you able to walk several miles or to “rough it” on your outreach if it is required of you?*
- Yes
- No
If no, please explain
List any medical, first aid, or CPR training
In case of an emergency, please notify: Name*
First Last
Relationship*
Phone*
Primary Physician Name*
Clinic*
Phone*
I agree to abstain from alcohol, tobacco, and illegal drugs during this outreach.*
- Yes
- I have concerns I'd like to discuss
NOTE: Many of our teams work with people who are struggling with substance abuse and your loving discretion is very important.
Please explain
Do you have a fear of flying?
- Yes
- No
Does it really bother you being away from your spouse and/or children?
- Yes
- No
- Not applicable
Do you understand that we will be praying and studying the Bible daily on this trip?*
- Yes
- I will participate but ask not to read or pray out loud.
Comments
I agree to participate in all the team’s activities and I am committed to the unity of the team.*
- Yes
- No
I understand and agree to meet all financial deadlines for raising support for this trip.*
- Yes
- No
I have read and understand all of LightShine's policies and agree to abide by them.*
- Yes
- No
I give permission for LightShine Ministries to use photos of me for future promotional purposes.*
- Yes
- No
Select your t-shirt size by checking one of the following:*
- Small
- Medium
- Large
- XL
- XXL
Verification of Medical Insurance Coverage
LightShine International Ministries (LSIM) requires that all team leaders and team members have adequate medical insurance. Some family health insurance policies cover short-term travel; some do not.
You must verify with your insurance carrier that your current policy will cover you while on the mission for which you are applying. If you do not have health insurance for this trip, we can suggest a company that will offer insurance just for your team assignment.
Insurance Company*
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Policy #*
Group #*
RELEASE OF LIABILITY AND RELEASE TO OBTAIN MEDICAL CARE

Matthew 18:15-20 and I Corinthians 6:1-8 instructs us to live at peace and to resolve disputes in private or within the Christian church. I acknowledge my concern that the limited charitable resources of LSIM should not be dissipated on wasteful litigation. Therefore I expressly waive my right to file a lawsuit in any civil court or other secular setting against LSIM and other organizations and all individuals involved with this mission trip.

I hereby release all leaders and organizations involved with this mission trip from any and all legal liability. I hereby waive all my rights to any legal liability, on the part of LSIM or any other individuals or organizations involved, which liability may result from sickness, injury, or death that may occur on or relate to this trip. I fully realize that there are hazards, and I am fully assuming these risks, including but not limited to, hazardous travel, poorly constructed roads, animal attacks, dangers resulting from military or political activities, sickness, disease, inadequate health care, kidnapping, arbitrary imprisonment, and all other unforeseen risks.

I specifically release LSIM and all concerned from any claim of negligence in their duties as leaders, or otherwise, on this mission trip. In the event that I attempt to make a claim in violation of my release and waiver as herein indicated, I hereby agree to, and shall pay, all legal fees and costs incurred by LSIM and other individuals and organizations involved.

I hereby further acknowledge my responsibility to provide my own insurance coverage of any and all types, including but not limited to, medical, hospitalization, life, disability, death, lost baggage, lost or stolen personal property, and any and all other insurance which I may need or desire. I also hereby release LSIM and all leaders and organizations involved with this mission trip from responsibility to provide insurance coverage of any and all types.
I hereby further authorize the leadership of LSIM to make essential decisions on my behalf with respect to medical treatment, emergency surgery, or hospitalization, should such be necessary. However, LSIM shall in no way be responsible or liable for payment of any and all bills for such medical treatment. I assume the full responsibility for any and all medical bills incurred related to this outreach. My estate and my family shall further assume full and total cost for the return shipping of my body should I die by any cause on this trip.

I further agree wholeheartedly to abide by decisions made by leaders and all those in authority and by all guidelines, policies, and rules pertaining to this trip, including but not limited to LSIM team policies.I have read and am in full agreement with this release and waiver, and fully understand that I am: waiving any rights I may have to litigate and sue; accepting full responsibility for all insurance, all medical costs, and all risks related to this trip; authorizing LSIM to make medical decisions if necessary; and agreeing to read and abide by all guidelines, policies, rules, and leadership decisions pertaining to this outreach. I certify that all the information I have given on this team registration form is accurate and true to the best of my knowledge.

By signing this form, I acknowledge that I understand and agree with everything stated on this form.
Date*
MM slash DD slash YYYY
Signature*
Registration Fee*
Price:
Total
$0.00
Name
This field is for validation purposes and should be left unchanged.

LightShine Ministries P.O. Box 777 Mount Joy, PA 17552

Verification of Medical Insurance Coverage

RELEASE OF LIABILITY AND RELEASE TO OBTAIN MEDICAL CARE

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LightShine Ministries Alaska