Information Flyer
2016 Parent/Teen
Guatemala Mission Trip
When: June 26 – July 5, 2016
Cost: $1450 per person
*Money not due all at once, There is a payment schedule.
Price includes: Airfare, food, lodging at a hotel, transportation, ministry supplies,
and site-seeing and overnight in Antigua for cultural emersion trip. 
Only extra money you will need is for souvenirs, snacks and food for airport days of travel.
Application & $75 deposit per person due Dec. 13, 2015.
*We can take credit card payment, there will be a service charge fee.
Who can go: Teens in middle school or high school who are active members of the
Epicenter youth ministry. If you are in middle school, you need one parent to go with you on
this trip. If you are going to be in 9th grade in fall 2016, or currently in high school, then you may
go on this trip without a parent.
Examples of things we will be doing:
We will be working with our missionary Myra who runs a feeding clinic for mothers and
children. Our team will be doing a week-long Vacation Bible School. We will also be handing
out food and pigs at her feeding program.
Very Important Information: You will need a valid passport.
If you are a US citizen, all you need is a passport. If you are not a US citizen,
you will need to secure a VISA to get into Guatemala. (Please check with the
Guatemalan embassy with any questions or concerns.)
Youth Short Term Missions Application
Epicenter Youth Program
Immanuel’s Church ● 16819 New Hampshire Avenue ● Silver Spring, MD 20905
For more info, please contact Pastor Jenny, (301) 989-4673, x1279 or jchilders@immanuels.org
Please Print or Type your application.
Please insure your entire application is filled out and signed by your parents/guardians.
Dates of Trip: June
Today's Date:
26 – July 5, 2016
PERSONAL INFORMATION
(Please check one of the following) Male: _____
Female: _______
Name: _____________________________________________________________
(Please give your first and last name as it appears on your birth certificate.)
Do you have a nickname you prefer to go by? ______________________________
YOUR ADDRESS:
Phone: _______________________________________
Current Grade: ______________
Cell Phone: ___________________________________
How old will you be while we are in
Guatemala?
Your E-Mail: __________________________________
__________ years old
When is your birthday?
Parents E-Mail: ________________________________
__________________________________
What is the best way to reach your parents?
____________________________________________
MEDICAL INFORMATION
Age: ________________
Are you allergic to any medication? _____________________
If yes, please specify: ___________________
If you have any special dietary considerations or allergies, please list them here: ___________
In case of an emergency while we are in Guatemala:
Relationship of person to you:
EMERGENCY CONTACT
___________________________________
Name: ____________________________
Address: _____________________________________________
Phone: ___________________________
_____________________________________________________
CONSENT FOR TREATMENT
In case of emergency, I hereby agree to the performance of such treatment, including anesthesia and surgery, as the
attending doctor or physician may deem necessary.
Parent Signature: _________________________________________________________
Youth Signature : __________________________________________________________
Date: ______________________
RELEASE OF LIABILITY
I do hereby release IMMANUEL’S CHURCH, its staff, pastors, agents and volunteer assistants from any liability
whatsoever arising out of any injury, damage or loss which may be sustained by myself or my family member during
the course of involvement with the short term mission outreach of Immanuel’s Church anywhere in the world.
Parent Signature: _________________________________________________________
Youth Signature: __________________________________________________________
Date: _________________
Would you be willing to forego personal preferences to honor the people you will be serving?
(Please circle one)
Yes
No
If you agree to the following, please sign your name below.
a) I realize that I may be asked not to wear an article of clothing I brought with me. (i.e.: if clothes are too tight or
too short.) I will do this without complaining.
b) I realize I will have to share a room with my fellow youth group members.
c) I realize that I will be waking up early every morning.
d) I realize that my adult leaders will never ask me to do something that would compromise my safety and at all
times I must be willing to receive instructions from my adult youth leader and do what is asked of me.
e) I realize that I am going to Guatemala to serve. I will be asked to work hard, and I will be asked to give 100%.
I will do this without complaining or being rude.
f) I realize that I am going to Guatemala as a member of a group. I will do my best to encourage and support my
other group members.
I agree to all of the following:
Signature of Youth: _______________________________________
Date: _____________
21. Please use the space below to provide any additional information you would like us to have.
My signature indicates that I agree to the following:
I agree to attend the team meetings, training sessions, debriefing, and participate in any
post-trip informational meetings concerning our trip. I realize that failure to meet these
requirements may mean that I am asked to step down and not participate in this mission trip.
I agree to honor the leadership, to adhere to the policies of the Immanuel’s Church, and to
conduct myself in a manner consistent with biblical standards.
Parent Signature: ___________________________
Youth Signature: ____________________________
Date: ___________
Date: ________
Life Style Guidelines for
Guatemala Summer Mission Trip:
The following lifestyle guidelines must be followed if you are going to be a member of our
mission trip this summer.
1. I commit myself to living a life of purity. I will not become involved in any
inappropriate relationships with any members of my team or the youth we
will be working with.
a. I will not kiss, hold hands, or engage in any behavior of a sexual nature
with anyone on my mission’s team.
b. I will not start dating someone on my team, especially while in Guatemala.
c. If I am asked by any of the adult leaders to modify my behavior concerning
a member of the opposite sex, I agree to follow their re-direction.
2.
I commit to being a supportive member of our team.
a. I will not make fun of any member of our team.
b. I will do my best to encourage my team members and not complain.
c. If I am frustrated, I will go to one of my adult leaders. I will not use my
frustration as an excuse to gossip of speak ill of someone else.
d. I will keep my hands and feet to myself at all times. I realize that it is
completely unacceptable for me to ever put my hands on another team
member.
3.
I commit to working on my relationship with the Lord and living a life
worthy of a Christian.
a.
b.
c.
d.
e.
I commit to having a daily quiet time and read my bible.
I will not use illegal drugs, alcohol or tobacco products.
I will not use profanity or joke in a crude or unkind manor.
I will represent Jesus to my team mates and the people in Guatemala.
I will watch how I conduct myself via social media. Using profanity, being
sexual or ungodly via social media is not living a life worthy of a Christian.
f. I will guard my mouth and my actions with my parents and my family.
Once I become part of the 2016 Guatemala Mission Team, I will be held to a higher standard of
behavior. I realize that it is a privilege to be going to Guatemala and if I do not adhere to the life
style guidelines, I will not be allowed to go on this trip.
1 Timothy 4:12 lays out what a Biblical lifestyle for a teen looks like:
Don’t let anyone look down on you because you are young. Instead, set an example for the believers
through your speech, behavior, love, faith, and by being sexually pure. - 1 Timothy 4:12 (CEB)
Parent Signature: _________________________________
Date: _________________
Youth Signature: _________________________________
Date: _________________
Mission Meeting Schedule
Our meetings will be from 1:30 – 2:30 pm on the following Sunday Afternoons.
We will be meeting in the middle school room, room 113.
*If you miss more than one meeting, you will have to have a meeting with Pastors Jenny and/or
Shenan. We consider our meeting times very important and an important part of the whole
mission’s trip process.
Mission Meeting Dates
Sunday January 10th: First missions meeting – please be here. A LOT of
information is handed out at this meeting.
Sunday March 6th: Team Building and information
Sunday May 1: Team Building and information
Sunday June 19: Mandatory Meeting: This is our last meeting, parents and teens
both must attend this meeting. It will be a short meeting for last minute questions and details.
Payment Schedule Guatemala 2016
Here is your payment schedule:
Payment Schedule
Sunday, December 13: $75 deposit due
Sunday March 6th: $610 payment due – to cover airfare
Sunday May 1: Final Payment - $765 is due to pay off balance of trip.
**After March 6th – All money paid is non-refundable.**
If you must drop out after the plane ticket is purchased, you will
have a ticket in your name to use for one year. Any money for your
trip raised by group fundraising is non-refundable.
Youth Signature: _________________________________
Date: _______________
Adult/Parent Signature: _________________________________
Date: ___________
Your application will not be considered without this page, so please make sure to
include this with your application. Thank you 