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APPLICATION 
    
   
   
Nets of Arukah Ministries, Inc.
DOMESTICS MISSIONS APPLICATION: SHORT-TERM TRIP
Completed application and pastor’s recommendation must be received no later than six (6) weeks prior to the scheduled dates of the trip.  This typically coincides with the first scheduled meeting for the trip.
Please complete this application, scan and e-mail to: [email protected] Bring the original completed form with you to the first team meeting.









Please Staple Wallet Size Photo Above

Date(s) of mission trip: _________________________________

NAME OF TEAM MEMBER: (as it appears on your passport or identification card) Last First Middle
__________________________________________________________________________________________
Team/Group Name: Nets of Arukah / Pine Ridge

Team Leader:                                                                                                                             
Email Address: [email protected]
I. Contact information
E-Mail: ___________________________________________________________________________
Cell Phone: ________________________________________________________________________
Home Phone: ______________________________________________________________________
Mailing Address: ___________________________________________________________________
Physical Address (if different): _______________________________________________________

II. Personal Information
Name / nickname you prefer to be called: __________________________________________________________
Age ____
Male / Female
Marital Status: Single ____           Married: _____
Spouse’s Name: ______________________________________________________________________________

III. Personal Identification information
Passport Number: ___________________________________________________________________________
Date of Issuance: ___________________________________________________________________________
Date of Expiration: ___________________________________________________________________________
Place of Birth: _______________________________________________________________________________
Birth Date: (mm/dd/yyyy) ________________________________________________________________________
IV. Emergency Information
Name of emergency contact: ____________________________________________________________________
Relationship to you: ___________________________________________________________________________

Street Address or P.O. Box                                                                                                                       
City, State, Zip+4:                                                                                                                                 
Day Time Telephone (Area Code): _____________________________________________________________
Evening: __________________________________________________________________________________

Parent information may be omitted if you are over 18 and your own legal guardian!

Father/Guardian’s Last Name First: _____________________________________________________________
Phone: ________________________________________________________________________
Mother/Guardian’s Last Name First: ____________________________________________________________
Phone: _________________________________________________________________________
 If parents are divorced, who has legal custody? _________________________________________

V. Medical Information
Note: The following information will not necessarily prevent you from volunteering with Nets of Arukah, but it will be to your benefit for leadership to be aware of your medical history.
Have you ever had or been treated by a doctor for any of the following health problems:
(Check each area where have been treated for or have seen a physician.)
1. Diabetes _____   2. Seizures_____   3. Fainting spell_____   4. Eating disorder_____   
5. Respiratory problems____ 6. Psychiatric care____   7. Depression_____   8. Asthma or chronic wheezing_____
 9. Chronic persistent cough or shortness of breath_____ 10. Tuberculosis_____
 11. Any skin disorder or disease other than acne_____ 12. Chronic or recurrent ear or eye problems_____
 13. Impairment of hearing or vision. Cataracts or glaucoma_____
 14. Persistent, recurring indigestion, stomach or duodenal ulcers_____
 15. Gall bladder stones or colic_____ 16. Jaundice, cirrhosis or other liver problems_____
 17. Intestinal or bowel problems, colitis, hemorrhoids, other rectal problems or bleeding_____
 18. Any test results indicating exposure to the AIDS virus_____ 19. Kidney problems_____
 20. Rheumatism, arthritis, or other forms of swollen painful joints_____   21. Serious bodily injury_____
 22. Chronic back pain, back injury or surgery_____ 23. Cancer_____
 24. High blood pressure, heart murmurs or other cardiac problems_____
 25. Severe migraine headaches_____ 26. Anemia or other blood disorder_____
 27. Severe allergic reactions to either food, medicines, bee stings or any other insect bite/sting_____
 28. Treated for alcohol or drugs_____ 29. Unusually sensitive to heat_____ 30. Physical disability_____
 31. Other allergies_____ 32. Special Dietary Requirements_____   33. Other ___
If yes, please explain (be sure to include any information about food allergies or special diets) ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Are you now taking, or will you be taking any medications:   No / Yes
List Medications/Dose/Condition:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are you currently under the care of a physician or other specialist (including psychiatric care)?  No/Yes
If so, what and list the physician or care-giver:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             

Do you have any physical or other health related issues that would prevent you from participation in physical labor?  No/Yes
If so, please explain:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

Do you have any mental or emotional issues that may prevent you from participating in certain functions or activities, such as bouts of depression, past traumas that are triggered, and so forth?  No/Yes
If so, please explain:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

VI. Christian Service
Home Church: _____________________________________________________________________________
Name of Pastor: ____________________________________________________________________________
Address/City/State/Zip: ______________________________________________________________________
Phone: ______________________________________
Email: ________________________________________
How often do you attend church?                                                                                                   
Describe your involvement in your church and Christian service:___________________________________________________________________________________________________________________________________________________________________________________

What do you desire to gain from participating in a mission’s trip? _____________________________________________________________________________________________

How do you desire to benefit those you serve?
__________________________________________________________________________________________________________________________________________________________________________________________

Please describe the following: (In approximately 150 words each) Use separate sheet of paper if needed.
1. When and how did you come into a personal relationship with Jesus Christ as your Savior and Lord:
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Describe your current relationship with God, including how you are seeking to share Christ with others now:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. Describe the things you are doing to develop and grow in your relationship with God and how those things are impacting your daily life:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

Name three (3) people who you currently work with:
1) Name:                                                            Phone Number:                                                  
2) Name:                                                            Phone Number:                                                  
3) Name:                                                            Phone Number:                                                  

VII. Experience
Employment: Part-time    Full-time           Retired               Student              Military
Level of education you have completed:                                                                                          
Describe your present employment or type of education:                                                                                                                                                                                                                                                                                                                                                                                                        
Have you ever traveled overseas? No/Yes
If yes, where and when:                                                                                                                                                                                                                                                                                                                                                                                                                                                    

Do you speak any foreign languages? No/Yes
If yes, indicate language and proficiency level:                                                                                                                                                                                                                                                                                                                                                                                                                      

What experience do you have working with other cultures?                                                                                                                                                                                                                                                                                                                                                                                                     

Have you ever been on a mission’s trip before? No/Yes
If yes, where and when:                                                                                                                                                                                                                                                                                                                                                                                                                                                    

Within the past year, have you been involved with any of the following:
Tobacco             Alcohol                         Illegal Drugs       Gang Activities
If so, describe your involvement:                                                                                                                                                                                                                                                                                                                                                                                                                                       
Have you ever served time in a detention center or jail or been convicted of committing a crime? No/Yes
If so, please explain (including dates, jurisdiction, and any outcome or sentencing):                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
Have you ever been involved with a cult or the occult? No/Yes
If yes, please explain (includes dates):                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
Of the activities listed below, mark those in which you have training with a ‘T’, experience with an ‘E’ and if you are experienced with an ‘X’:
___working with preschoolers        ___door-to-door outreach               __drama                                    
___working with pre-teens /teens    ___Vacation Bible School             ___speaking to groups
___household cleaning                  ___painting                                ___mixing cement
___electrical                               ___plumbing                              ___construction – general
___plastering                              ___raking leaves                          ___masonry
___auto mechanics                       ___teaching                                ___puppets/clowning
___music/singing                        ___cooking meals                        ___hanging and folding laundry
___simple carpentry                     ___sewing                                  ___computers (networking/tech)
For the items checked, please provide any detail you think might be helpful:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
List and describe three of your positive aspects or strengths:
1)                                                                                                                                                        
2)                                                                                                                                                        
3)                                                                                                                                                        
List and describe three of your weaknesses:
1)                                                                                                                                                        
2)                                                                                                                                                        
3)                                                                                                                                                        


VIII. Additional Information
Include any other information about yourself that you feel would be helpful:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
Please provide the name and telephone number of one reference (not a relative) that we may contact.
Contact name:                                                                 Phone Number:                                                  
Relationship to you:                                                        Years you have known them:                                

WORKING WITH NATIVE PEOPLES
Because you are traveling to a Native American Reservation with a different culture, we have stringent policies that our short-term ministry partners follow while they are there. We do this for the safety of our ministry partners and in respect of the leaders and our hosts on-site. All ministry partners are under the supervision and direction of the team leader and leadership of the local ministry or organization where they will be serving. Our ministry partners need to understand that they will be expected to work the same or similar schedule as the hosts and those whom are designated by them to work with us. In addition, we may be sharing meals and devotionals with the local people at times and places that may alter your current schedules. Time off and leaving the site of the ministry must be cleared with the team leader and the local ministry leader. Because of differences in cultures and communication, dating while on a mission trip is strictly prohibited. Unmarried couples, even those engaged, are to refrain from all forms of physical contact, including hand holding, hugging, kissing and sitting on laps both in public and in private. Please remember, we send ministry partners to serve as representatives of Christ.
Your signature below states acknowledgment, agreement, and adherence to the Nets of Arukah Ministries, Inc. policies, without exception.
Participant Signature:                                                        Date:                                                               
Printed Name:                                                                 Parent/Guardian (if minor):                                   
ALCOHOL, TOBACCO & DRUG POLICY
Because of cultural perceptions and possible stumbling blocks which could result, the Nets of Arukah Ministries, Inc. has a stringent policy against the use of illicit drugs or the consumption of alcoholic beverages of any kind on route to and/or on the mission field.
Tobacco may be used but only in designated areas and in a manner that is not offensive to others or to our hosts.  The native people often use tobacco to honor their elders or in ceremonies and we honor that as well.  However, distribution of tobacco to the local people shall only be done at the direction of the host or team leaders.
My signature below states acknowledgment, agreement and adherence to the Nets of Arukah Ministries, Inc. alcohol, tobacco and drug policy without exception.
Participant Signature:                                                        Date:                                                               
Printed Name:                                                                 Parent/Guardian (if minor):                                   

RELEASE AND INDEMNIFICATION AGREEMENT
I, the undersigned (and we the parents or legal guardians and/or custodians of the undersigned if a minor or under legal disability) in consideration of the services and sponsorship of the Nets of Arukah Ministries, Inc. and local ministry hosts, (hereinafter referred to as HOSTS) and other valuable consideration, and permission of HOSTS for me to go on a short term mission project under its auspices, HEREBY RELEASE AND AGREE TO HOLD HARMLESS all HOSTS and its officers, employees, agents and servants, from any liability whatsoever, as the result, whether immediate or proximate or not, of my participation in the short-term mission trip sponsored by the HOSTS; and I specifically agree to personally provide any and all insurance policy protection. I totally agree that members serve at their own risk and the HOSTS are not liable in the event of sickness, accident, death, terrorist acts, transportation or any other expenses beyond that of normal involvement.

I also hereby acknowledge that the information I have given the HOSTS is accurate and true to the best of my knowledge. I understand that any team member who is over the age of 18 will possibly be subject to a background check. My signature below will give the HOSTS authority to obtain any files or records needed in order to conduct such a background check. I hereby waive all rights or claims to privacy in relation to this background check. This check only applies to criminal files and only for the period leading up to the trip.
I also give the HOSTS the right to use my picture, voice and/or testimony in any form for promotional or advertising materials. My enclosed signature (and signature of my parent or legal guardian, because I am under the age of 18) signifies my approval of all limitations listed above.
Name of Participant (printed):                                                                               
Signature:                                                                       Date:                           
                                                                                                Month/Date/Year
Name of Guardian (printed):                                                                                  
Signature:                                                                       Date:                           
                                                                                                Month/Date/Year

CASH DONATIONS AND GIFT POLICY
I agree to communicate directly with the leadership in charge about any desire to bless them or any child or worker that is affiliated with the ministry that I am serving at. I agree that any gift given is not tax deductible and to get a tax receipt it must be run through my local church or through our partner ministry. I do choose to obey and follow policy listed above. If I want a tax receipt I will send specific contributions and/or gifts to the Nets of Arukah Ministries, Inc. with instructions designating my gift to the appropriate cause I wish to support.
Participant Signature:                                                        Date:                                                               
Printed Name:                                                                 Parent/Guardian (if minor):                                   
REFUND POLICY
To receive a tax deduction, the IRS stipulates that the donor must release control of the funds donated to the non-profit organization. For this reason, donations cannot be designated for an individual's personal use. Each participant who raises funds will be given credit for the funds raised. The funds received are not refundable. If an individual is unable to participate in the Nets of Arukah Ministries, Inc. mission trip, the funds he/she has raised, less incurred expenses and administrative fees, will remain credited to his/her account for up to one year. Credit for the funds received may be transferred to a Nets of Arukah Ministries, Inc. project or missionaries or other applicant of his/her choice only by written request.
Participant Signature:                                                        Date:                                                               
Printed Name:                                                                 Parent/Guardian (if minor):                                   

TRAVELERS INSURANCE
The Nets of Arukah Ministries, Inc. requires that each team member acquires Traveler’s Insurance.
Insurance Company ________________________________
Policy Number: __________________________________
Effective Dates ____________________________________
Participant Signature:                                                        Date:                                                               
Printed Name:                                                                 Parent/Guardian (if minor):                                   




















NETS OF ARUKAH MINISTRIES, INC. DOMESTIC MISSION TRIP
PASTORAL RECOMMENDATION FORM
Please have this form completed by your pastor or spiritual leader of your church and return it to Nets of Arukah Ministries, Inc. 1617 Wittenberg Boulevard East, Springfield, Ohio 45506-3116 or scan and email directly to [email protected]

Completed pastor’s recommendation must be received no later than six (6) weeks prior to the scheduled dates of the trip.

Dear Pastor:

                                                                         is applying to serve as a short-term missionary with Nets of Arukah Ministries, Inc. 

Our short-term trips to work with the Native Americans is one in which we endeavor to bring hope, healing and restoration to those we meet as well as to those who participate in this mission with us.  If you would like more information please feel free to contact us at the above address or e-mail and we will be glad to meet with you and discuss this further.  

With this in mind, and on behalf of the above listed individual, please complete the following form and return it to the above email address at your earliest convenience.

Thank you and blessings,

Thomas M. Lauber, Sr.
CEO – Nets of Arukah Ministries, Inc.



PASTOR’S RECOMMENDATION

I have read this application, and to the best of my knowledge all the information is complete and accurate. Based upon my personal knowledge of the applicant over the past           (years/months). I give the following recommendation for their participation on a trip with the Nets of Arukah Ministries, Inc.

Strongly Recommend ___

Recommend ___

Recommend with Reservation ___  

Do Not Recommend ___

(If you do not strongly recommend please explain on a separate piece of paper and
attach to this form.)

Do you believe the applicant will be able to submit to authority and adapt to a new culture?

Strongly ___

Agree ___

Agree Have Reservations ___

If there is any other information not included on this application that you feel we should be aware of, or if you have any additional comments concerning the applicant, please describe in the space below or on a separate sheet.

Name (printed):                                                                                 

Position:                                                                                             

Signature:                                                                                Date:                                      

Please in your own words provide us with your thoughts on the character and
personal nature of the applicant. We are looking to see if there are any issues prior
to the trip to avoid conflict or by putting someone in a position they are not ready
for.