Houston Mission Trip Registration Packet

Sr. High Mission Trip
August 12-14, 2015
Sunday (Day 1)
Registration Packet
Cost - $200
5:00 pm
6:30 pm
8:00 pm
11:00 pm
Monday
2) Travis @7:00 am
For Scholarship
Info (Day
E-mail
12:00 pm
tberry@windwoodpc.org
2:00 pm
5:30 pm
$50 Deposit & Paperwork - Sunday, April 12
7:00 pm
$150 Final Payment - Sunday, June 28
11:00 pm
NEW THIS YEAR: Students who bring a friend to FITS will only
need to pay $100 for the Mission Trip and
Tuesday (Day 3)
7:30
their friend can come for FREE!
am
9:30 am
12:00 pm
This is just a sample schedule. We will meet at the Rock
early Wednesday morning and have a full day at the
ministries. We will return to the Rock late Friday evening.
Sample Schedule
Sunday (Day 1)
5:00 pm
6:30 pm
8:00 pm
11:00 pm
Arrive at CSM housing and unpack
Dinner at Cuu Long Quan (Vietnamese)
Orientation and expectations
Lights out
Monday (Day 2)
7:00 am
12:00 pm
2:00 pm
5:30 pm
7:00 pm
11:00 pm
Depart for The Waystation to help cook/serve breakfast for homeless
Lunch at housing site
Serve at Ujima-Gulf Coast Arms (Kids club at Section 8 apartment complex)
Dinner at Reggae Hut (Jamaican)
Prayer Tour and reflection
Return to CSM housing for lights out
Tuesday (Day 3)
7:30 am
9:30 am
12:00 pm
1:00 pm
4:00 pm
6:00 pm
8:00 pm
11:00 pm
Breakfast at CSM and Devotions led by group leader
Depart for Houston READ Commission literacy/tutoring program for adults
Lunch at park
Serve at Ujima-Gulf Coast Arms (anchor site for the week)
First Ward Prayer Walk
Dinner at Laredo Taqueria (authentic Mexican tacos)
Return to CSM housing for debrief
Lights out
Wednesday (Day 4)
8:00 am
9:00 am
12:00 pm
1:00 pm
4:00 pm
Thursday (Day 5)
7:00 am
8:00 am
12:00 pm
1:00 pm
4:00 pm
6:30 pm
8:00 pm
11:00 pm
Breakfast at CSM and Devotions led by group leader
Depart for Kid’s Meals food delivery
Lunch at park
Serve at Ujima-Gulf Coast Arms (anchor site for the week)
Park Place Neighborhood Prayer Walk
Dinner at Yildizlar (Middle Eastern)
Debrief at the Water Wall
Lights out
Friday (Day 6)
8:00 am
9:00 am
12:00 pm
1:00 pm
6:00 pm
7:30 pm
11:00 pm
Breakfast at CSM and Devotions led by group leader
Depart for SEARCH – resource center for the homeless
Lunch at park
Serve at Ujima-Gulf Coast Arms (anchor site for the week)
Dinner at Thai Spice
Final Challenge and Evaluations
Lights out
Saturday (Day 7)
8:00 am
9:00 am
Breakfast at housing
Closing, clean, pack-up, and depart
Breakfast at CSM and Devotions led by group leader
City Search (Inner-city scavenger hunt)
Lunch at housing site
Serve at Ujima-Gulf Coast Arms (anchor site for the week)
Misión Milby (Youth worship at our housing site student ministry – includes
dinner)
7:00 pm
Concert with Harbor Light Choir
8:30 pm
Debrief
11:00 pm Lights out
Note: Because CSM wants to customize your trip for your group, not only will ministry sites vary every day, but scheduling
can also accommodate special events that you may have arranged or that we may have arranged for you.
What to Bring
…and What NOT to Bring on your Mission Trip to Houston
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________
Five things to remember about the City:
1. The people who live in the city come from many different places, backgrounds, and cultures. Different isn't
good or bad.
2. The people of the city work hard at preserving their cultures…they are proud to be Korean, Thai, Salvadoran,
Honduran, Mexican, African-American, etc.
3. You will bring your suburban/rural culture with you. You will naturally look, act, and talk like suburban/rural
people.
4. Sometimes these cultures are in conflict. Please remember to respect the cultures of the city that are
different from your own. Do not make fun of or denigrate the dress, actions, food, or music of the cultures
with which you come in contact. This also includes different religious groups, ethnic cultures, sexual
orientations, political views, etc.
5. The city is inconsistent. We ask that dress be modest and appropriate to the situations you will be in. This
is regardless of the attire that you may see others wearing who are not part of CSM. Many work sites that
deal with food require tennis shoes or other closed shoes with non-skid soles – no open-toed or open-heeled
shoes such as sandals, flip-flops or clogs.
Things to bring with you to the City:
•
An attitude of FLEXIBILITY! And remember, Houston is in the Central Time Zone!
•
Please make every effort to use VANS for your group’s transportation. Make sure there is room for
your CSM City Host in your vehicle.
•
Sleeping bag or twin sheet, pillow, towel, wash cloth. (All participants will have a bunk bed or
mattress).
•
Personal toiletries (shampoo, soap, toothbrush, sunscreen, etc.)
•
Fan in the summer (optional).
•
Your Bible, a pen and a journal.
•
Work clothes: most sites prefer jeans/long pants, t-shirts, closed-toe shoes with non-skid soles.
o
o
o
o
o
o
•
Shirts that expose the shoulders (tank tops, etc.) may NOT be worn.
Shirts must be long enough to raise arms without exposing midriff or underwear.
For summer, shorts to wear around our housing site and at most ministry sites (modest length)
Sturdy, flat, closed-toe shoes with non-skid soles for use at most ministry sites.
Sandals or flip-flops may be worn around the CSM buildings, but be prepared to change.
One-piece swimsuits with modest cut for females, only in summer.
Church clothes (only if you will be in Houston on Sunday morning): Please check with your CSM
City Director because different churches that we visit have different requirements.
OPTIONAL: Sheet to lay your sleeping bag on, Flip-flops.
LEADERS: Alarm clock.
Things NOT to bring to the City:
•
Any headphone devices such as iPods or MP3 players, portable gaming systems, TVs. (We prefer
that students not bring cell phones. If you do, they must be left at the housing site.)
•
Anything that is not replaceable or has significant value, like expensive jewelry.
•
A lot of money (CSM t-shirts are available for $10 to $20.)
•
Drugs, alcohol, knives, guns, weapons of any kind, etc
•
If planning VBS activities, please be creative and do not use the “Salvation Bracelet” craft, as the
colors can easily be misinterpreted and offensive to certain cultures.
Windwood Presbyterian Church
Houston 2015 Sr. High Mission Trip Registration/Consent Form
Wednesday – Friday August 12-14, 2015
Return this form by April 12, 2015
Student Name: _______________________________________Grade: ________
Address: ____________________________________________ T-shirt size: ___
Phone: (H): _____________________ (Student) Cell: ____________________
Parent (s) Name: ___________________________________________________
Parent (s) Phone #’s (C): _________________ (C):____________________
Parent email(s) ____________________________________________________
Secondary Emergency Contacts – Name & Phone:
1.________________________________________________________________
2.________________________________________________________________
Please list any medications that will need to be given while on the trip:
_________________________________________________________________
Please list any allergies______________________________________________
I hereby release any and all potential claims or causes of action against
Windwood Presbyterian Church, which may arise in the event of an accident to
my child, and expressly acknowledge that we are releasing Windwood
Presbyterian Church, its agents, staff and volunteers in all respects from any
potential liability.
I hereby give permission for my child to receive medical attention while in the
care of Windwood Presbyterian Church representatives during the duration of the
Mission Trip.
Please note any activities you DO NOT wish your student to participate in. My
child is NOT allowed to participate in the following activities:
_________________________________________________________________
Parent/Guardian Name: _______________________________ (Please Print)
Parent/Guardian Signature: ____________________________
Date: ________________________________
2014-2015 MEDICAL AND SURGICAL WAIVER
Windwood Presbyterian Church
10555 Spring Cypress Road Houston, TX 77070 281-378-4040 281-378-4041 (fax)
Instructions:
The 2014/15 Medical and Surgical Waiver will apply to all youth events, trips, and projects from September 1, 2014 through
August 31, 2015. If you have already completed a form during this time frame, simply let us know. Its intent is to give
Windwood Presbyterian Church an adequate, current and useable record of each student’s medical information, and to
provide hospitals information they may need to have, including permission, in the event that any student needs medical
attention.Please be accurate and complete with each answer. It is the responsibility of the parent or guardian to keep this
information current, i.e., to update the information in the event of any change or additional information, which may need to
be added. Please have your signature(s) notarized. Many hospitals require notarization. (A notary is available at the
church at no charge! Contact Larissa.)
Personal Information:
Participant’s Name____________________________________ Birth date __________________
Spouse Name (if applicable)_______________________________________________________
Address_____________________________City________________State______Zip__________
Home Phone_______________________ Business Phone _______________________________
Parent/Guardian E-mail address:____________________________________________________
Medical Information:
Family Physician___________________________________Phone ________________________
List below (or write “none”), any physical defects or conditions that the participant has such as allergies, asthma,
nervousness, headaches, dysmenorrheal, etc. Please be complete, even if you do not currently consider any such condition
significant. Should the participant require medical attention at any time, list any special instructions (or write “none”) which
the participant might require such as being allergic to penicillin, having a rare blood type, etc. Again, please be complete,
even if you do not consider any such allergies or conditions significant. (Our goal is to be complete so that, in the event care
or treatment is needed, all known information will be available. Current Immunization (give date, or write “none”):
Tetanus__________________________________Polio_________________________________
Medical Insurance: (Attach a copy (front & back) of the medical insurance card)
Company Name_________________________________________________________________
Policy/Group Number______________________Phone ________________________________
Check here if participant has NO Medical Insurance [ ]
Waiver:
To be filled out by parents or legal guardians of participant of Junior High School and Senior High School
age:
I, __________________________ the parent and /or legal guardian of _____________________
A minor, hereby acknowledge that said minor is presently under my care, custody and control. I hereby give my
child, the said minor, permission to participate in any and all activities at and with Windwood Presbyterian Church
of Houston, Texas, in which he/she, with approval, registers to participate.
I further expressly grant my permission for my child to participate in all activities while an active participant on trips
and church events. In the event that emergency arises, necessitating medical or surgical attention, I hereby
consent and give my permission to Windwood Presbyterian Church staff, its representatives, and/or the sponsors
and any attending physicians, to make such decisions and to perform such medical treatments and/or surgery
upon said minor which may in their sole discretion be necessary and proper under the circumstances, I, the
undersigned parent and/or legal guardian of said minor, do release, acquit, discharge and covenant to indemnify
and hold harmless Windwood Presbyterian Church or its representatives, and sponsors, and any attending
physician, from any and all actions and causes of actions, related risks and damages, including injuries and
damages arising from their individual, joint, or concurrent negligence, injuries damages, and liabilities arising out of
the negligent treatment of any sickness or accident, and any and all financial responsibility for all medical
treatment of any sickness or accident, and any and all financial responsibility for all medical treatment provided
during the attendance of any trips.
I also assume responsibility for providing transportation from the event location should it be necessary for
disciplinary reasons.
Please do not fill this part out without a Notary. Larissa is a notary and is available upon request.
Parents’ or Legal Guardians’ Signature(s):
___________________________________________________________Date_______________
Printed
___________________________________________________________Date_______________
Signature
On this day personally appeared____________________________________________, who is/are personally
known to me and acknowledge to me that he/she/they is/are the parent(s)/legal guardian(s) of
_____________________________________ and that he/she/they executed this Medical and Surgical Waiver for
the purposes of allowing the named student to participate in church activities and to allow Windwood Presbyterian
Church, its staff, and sponsors to make decisions to obtain medical care should it become necessary and proper,
in their sole discretion, during such activities.
Sworn and subscribed before me on this the _________ day of________________________201__.
_______________________________________
Notary Public in and for the State of Texas