REGISTRATION FORMS: (Print these forms, fill them out, sign and date, and mail them to Mountain Heritage Missions)
Missions Week Dates: _________________________________________ Location: _________________________________________________
Name: ___________________________________________________ Age: _______________
Phone: ________________________________ Email: _______________________________
Gender: Male ______ Female: ______ T-Shirt Size: __________________________
Marital Status: Single _______ Married ______
Emergency Contact Info:
Name: __________________________________________ Relationship: ______________
When and where did you come into a relationship with Jesus Christ?
What is your general condition? ____________________________________________
Allergies (Food, Physical)? __________________________________________________
Special Dietary Needs? ______________________________________________________
Medical Insurance? __________________________________________________________
****Passport Information: (Only for trips to foreign countries)****
Name as appears on passport: ______________________________________________
Passport #: _________________________________ Expiration: ___________________
It is recommended that you check with the U. S. Department of State to
find out what they recommend for travel to the country being visited.
Immunizations are not required to travel with MHM. However, you
must be aware of this information and then pray and do as you feel led.
Ministry Experience & Giftings:
What is your experience in ministry? ______________________________________
Have you been on prior missions trips? Where? When?
Do you have skills and/or experience in a particular work area? _______ If so, what skills do you have that would be beneficial on this
missions trip? ___________________________________________________________________________________________________
Why do you want to go on this missions trip? ____________________________________________
**** Risk Statement: (Primarily for trips to foreign countries) ****
This risk statement is to advise participants with Mountain Heritage Missions (MHM) of the potential risks in visiting and serving in third world developing nations and to realize and take full responsibility for the consequences as one assumes those risks. We ask that you gather as much information as you feel necessary and, when you are completely satisfied and confident that this is what God wants you to do, read this form and if you agree, sign and return the registration form. Keep this form for your records. We count it a real privilege to assist you in your desire to participate in ministering to the Church of our Lord Jesus Christ. Traveling and working in other parts of the world carries with it certain risks not found or associated with work in industrialized nations such as the U.S.A. and Canada. These risks can include hazards to both your person and property through cross-cultural offenses, accident, disease, criminal acts, terrorist acts, weather conditions and inadequate medical services and supplies. There could be additional emotional and physical stress due to culture shock and a variety of ministry conditions.
We realize that it is not possible for us to predict or fully prepare you for every circumstance you will face. It is our goal to advise and prepare all participants of MHM short-term missions trips of the assumed risks associated with mission work in a foreign country and MHM policies through this risk statement. In addition, we suggest and encourage you to prepare yourself for service through a number of ways:
1. Prepare yourself spiritually, physically and mentally for service. 2. Read all you can on the potential country of service. 3. Contact MHM to obtain any information we may have. 4. Talk with missionaries (if possible) serving in the country. 5. Contact your government office, such as the U.S. State Department, to obtain the most up to date information on the area. 6. Take any additional steps you feel are necessary.
It is MHM’s policy to not place ministry participants in harm’s way, thus we seek to monitor and avoid any situation that may possess potential danger to those who travel and minister with our organization.
Special note: In view of the fact that insurgent, guerrilla and criminal groups commit crimes of kidnapping or other forms of criminal extortion as a means for demanding payment of ransom, it is important that you understand MHM’s policy in this area. We are deeply concerned for the well-being of each of our short-term participants and will pray and labor diligently for the release of any participant taken hostage. It is the policy that MHM opposes the payment of ransom in any form: cash, commodities, or services. Therefore participants with MHM should not assume that ransom would be paid for their release. This is a standard policy of missions organizations. This is to prevent all missionaries from being placed at greater risk as hostage taking would greatly increase. Ultimately we believe in the sovereign hand of God in such matters and continue to pray for His protection in areas of ministry. We believe that we are to walk by faith and not by sight.
1. All the information I have provided in this application is true to the best of my knowledge.
2. I have read the Risk Statement. I am aware of the hazards and risks to my person and property associated with serving overseas in a missions capacity.
3. This is to certify that I will not hold Mountain Heritage Missions liable for injury, disease, or delay of return or any other claims, while under the auspices of Mountain Heritage Missions.
4. I understand and accept the Mountain Heritage Missions policy regarding ransom payments described in the Risk Statement.
5. I agree to accept all financial responsibility for my Mountain Heritage Missions Short Term Missions trip.
Applicant’s Signature: __________________________________________________________________________________________
** Please make all checks payable to MOUNTAIN HERITAGE MISSIONS and send forms and payments to:
Mountain Heritage Missions, P. O. Box 653, 2535 Main Street, Surgoinsville, Tennessee 37873