"Go therefore and make disciples of all the nations, baptizing them in the name of the Father and the Son and the Holy Spirit, teaching them to observe all that I commanded you; and lo, I am with you always, even to the end of the age."—Matthew 28:19–20
APPLICATION FOR MOBILE TEAM OUTREACH (MTO)
Dates of Trip
Name (as it appears on your passport)
Are You Married?
Date of Birth
Home Phone Number
Cell Phone Number
Work Phone Number
Place of Employment
Emergency Contact Name
What is Your Emergency Contact's Relationship to You?
Emergency Contact Home Phone Number
Emergency Contact Cell Phone Number
Medical Insurance Provider
Medical Insurance Policy Number
Medical Insurance Provider Phone Number
Do You Have Any Allergies/Conditions/Disabilities?
Do You Take Any Medications?
If You Have Any Pre-existing Conditions, What Course Of Action Should Be Taken In An Emergency?
Are You A Member of CCOP?
If Yes, How Long Have You Been A Member?
If No, Please Write The Name of Your Church, Your Pastor's Name, and The Number of Years You Have Been a Member There.
What Activities or Groups Have You Been A Part of At CCOP?
What Talents, Skills, or Occupational Abilities Do You Have That You May Offer In Ministry?
Have You Had Experience In Any Of The Following? (Select All That Apply)
Small Group Leading Bible Study Leading Teaching Worship Leading Drama or Clowning Puppet Ministry Evangelism Medical Sports Arts and Crafts Leader Construction
List Any Languages You Speak And Please Mark Them According To Your Level Of Fluency: (B) Beginner, (I) Intermediate, (A) Advanced, or (N) Native
Do You Desire To Coordinate or Participate In Group Fund-Raising Activities?
Yes, I'd prefer to coordinate Yes, I'd prefer to participate No
Have You Been On A Mission Trip Before? If So, Please List Where, When, The Duration of the Trip, And The Name of the Organization you participated with.
Are You Willing To Commit To Attending and Participating in All Team Meetings, Homework Assignments, Fasting, and Spiritual Preparations For Your MTO?
MTO AGREEMENT OF INTEGRITY
"Who may ascend into the hill of the Lord? And who may stand in His holy place? He who has clean hands and a pure heart, who has not lifted up his soul to falsehood and has not sworn deceitfully."—Psalm 24:3–4
Please briefly explain why you desire to serve on this mission team.
I agree that I am in right relationship with God through faith in Jesus Christ. To my knowledge, there is no habitual sin in my life. I attest that my personal finances including my housing, car, and credit card bills are in good standing and not currently delinquent. During the mission preparations, process, and mission, I commit myself to the Lord and to being a team participant. I agree that I will serve both the people group to whom I will be sent, as well as the leadership which is in authority over me such as team leaders, home church, and indigenous ministries through whom I will serve. I am committed to respecting the people and culture to whom I will be sent. I will guard my words and actions, and dress appropriately according to the standards of their culture. I will apply myself wholeheartedly to the Lord in worship, prayer, ministry preparation, and in the sharing of my abilities for service. While traveling during the mission, I am committed to the safety of the team and will abide by all rules set by the team leaders. I understand that I a personally responsible for payment of the full amount of my mission trip expenses and I agree to submit payments within the given deadlines prior to the trip. If I fail to do so, I will incur the full mission trip expense (airfare and all other pre-arranged expenses) regardless of the termination of my trip.
Please enter your name and today's date in the spaces below to signify that you have read and agree to the above statement of integrity.
Due to the health risks within the country of destination, the US government requires or recommends vaccinations accordingly depending upon the circumstances within the destined nation. By entering my name below, I agree that I, or my legal guardian, will take all precautions, including all vaccinations if deemed necessary for the specific country to which I travel. I also agree that I will acquire the information and required vaccines within the recommended time-frame given by the health professionals who administer such vaccinations.
Further information and vaccines are available at: Allegheny County Health Department, 3441 Forbes Ave., Pittsburgh, PA 15213
Hours of operation: Mon, Tues, Thurs, Fri: 9am–4pm and Wed 1pm–8pm, Phone: (412) 578-8060.
MTO SHORT-TERM MISSIONS TRIP LIABILITY RELEASE AGREEMENT
This release contains the entire agreement between the parties relating to the subject matter.
(READ BEFORE SIGNING)
I, the undersigned missionary, desire to travel and participate in mission trips (the "Activities") organized through Covenant Church of Pittsburgh ("CCOP"). In return for the opportunity to participate in the Activities as organized by CCOP, I accept and agree that: By participating in the Activities, I may be exposed to potential risks, including, but not limited to, health hazards from food, water, disease, pests, poor sanitation, personal injury, death, crime, political instability, government opposition, and inadequate medical facilities (herein "Risks"). My participation in the Activities is voluntary, and I accept the Risks of my participation. I release CCOP and all of its agents from any and all liability for any and all injury, death, loss, or damage which may be incurred due to my participation in the Activities, whether or not caused by CCOP, its agents or associates, through their negligence or otherwise. I agree to indemnify CCOP and all of its agents and reimburse CCOP for any and all loss, liability, damage, expense, or cost which CCOP may suffer or incur, including attorney's fees, due to or in any way arising out of my participation in the Activities. I hereby authorize CCOP's representatives (agents) and members of the mission team, in case of medical emergency, to consent on my behalf to medical diagnosis, treatment, and care while I am participating in the Activities. If, in the opinion of CCOP's representatives, my conduct during the Activities jeopardizes the safety or success of the Activities or the mission team, my services in connection with the Activities may be terminated by CCOP, and I may be required to return home before completion of the Activities at my own expense. This release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by law. If any portion of the agreement is held invalid, the balance shall continue in full legal force and effect. This agreement shall be interpreted under Pennsylvania law without applying principles of conflict of laws. This release, waiver, and consent is binding upon myself and my personal representatives, heirs, successors, and assigns. The rights and benefits I grant hereunder to CCOP I also grant to CCOP's officers, directors, employees, representatives, and associates.
By entering my name in the space below, I signify that I have carefully read this release, waiver, and consent, I understand its contents, and I sign voluntarily.
AS PARENT OR GUARDIAN OF THE ABOVE-NAMED MINOR, I CONSENT TO HIS OR HER PARTICIPATION IN THE ACTIVITIES ON THE TERMS AND CONDITIONS SET FORTH ABOVE.
By entering my name below, I do hereby give permission to Covenant Church of Pittsburgh and its agents to take photographs, videos, and voice recordings and to use my likeness from photographs, videos, and recordings for the purpose of advertisement and promotions for Covenant Church of Pittsburgh. I understand that there is no financial compensation for the use of my likeness in photographs, videos, and in recordings.