Long Term Mission Trip

Personal Information

Medical Information

Emergency Contact Information

Skills and Experience

Spiritual Life

References

Note: Prior criminal history / drug use does not necessarily preclude one from serving as a long-term missionary or intern. Once again please understand that we need to ensure that the children at the City of Refuge will remain safe.

Please provide one pastoral reference and two personal references.

City of Refuge Rules and Regulations

The purpose of the following rules is for the protection of the children at the IMI City of Refuge. Appropriate action will be taken in the event that these rules are violated to include being banned from the City of Refuge. 1. All visitors must be scheduled and have prior approval from IMI management before entering any part of the City Refuge. Visitors must also agree to abide by all rules including but not limited to those listed here. 2. The use of illicit drugs or alcohol is strictly prohibited. 3. The promotion of any religion other than Christianity is strictly prohibited. 4. Appropriate language and conduct must always be maintained. 5. Children’s daily schedules, e.g. school, chores, meal time, homework time etc. must be honored. 6. Children are not permitted to leave the base alone. They are never permitted to leave with a missionary without prior staff approval. In certain cases, written approval that is cosigned by the gate guard on duty may also be required. 7. Visitors are never allowed to be alone with a child out of view of a staffmember. 8. Visitors may not enter any children’s dorm without a staff member. 9. No gifts of any kind may be given to child without prior staff approval. This includes candy, gum, soda, snacks, money etc. SODAS ARE STRICTLY PROHIBITED FOR CHILDREN. 10. It is common for children to ask to use your smart phone or tablet. This is strictly forbidden without staff supervision. 11. Visitors are never permitted to discipline a child. Behavior issues are to be brought to the attention of City of Refuge staff. 12. Discussions related to adoption or a child visiting America may take place solely and privately with IMI staff. Any discussion of these matters with a child is strictly forbidden and will not betolerated. 13. The City of Refuge is very safe. Parts of the surrounding community may not be particularly at night. Missionaries desiring to venture beyond the City of Refuge property may only do so with prior staff permission, in groups of four or more and during daylight hours. 14. Children are the primary focus at the City of Refuge. While we are not opposed to appropriate dating between men and women we are simply not set up to support unmarried couples. Nor do we have the time and energyto spend dealing with the myriad issues that arise and on correcting mistaken perceptions and confusion created within and among our children. If dating is your focus then the City of Refuge is not foryou. 15. Housing and kitchen standards and rules are posted in each unit and must be followed. 16. Long term missionaries must supply their own twin or queen sheets, (check with Josh) towels and laundry soap. 17. Dress Code: The purpose of the dress code is to provide reasonable expectations to assist in respecting the culture of the people of Honduras, as well as to exemplify the biblical principles we are working to instill in the children under our care. Please read the following guidelines and prayerfully consider the attire you plan to bring on your trip. Women/Girls clothing – Shorts, skirts and dresses MUST to be at least to the knee, on and off property. Capris are fine. Shirts that may reveal cleavage and spaghetti straps are NOT permitted. For church services outside the orphanage, a knee length or longer dress/skirt is preferred, otherwise pants are required. Transparent/see through clothing is NOT allowed. Please see Illustrations below for further clarification. Pool Attire: Women and girls MUST wear a shirt and shorts (running shorts are acceptable ONLY during swimming) over a swimsuit. Please use a towel or a wrap walking to and from your room to the pool. Men/Boys clothing – a shirt is always required except in the pool. Even so the sun is extremely strong here and many men and boys wear shirts in the pool as well. For church services outside of the orphanage, long pants are required. Clothing with drug- or alcohol-related symbols or phrases is not permitted. Tattoos have a strong tie to drugs, crime, and prison in this culture. As much as possible, cover your tattoos. We understand the weather can make this a challenge and will not require long-sleeved t-shirts, but please do your best to comply. Piercings are acceptable for girls/women, but only earrings. If you have a nose piercing, please remove it for the trip. Please remove any other piercings. PIERCINGS ARE NEVER ACCEPTABLE FOR MALES. Please remove them before coming. 18. Boundaries for interactions with the opposite sex. The City of Refuge is first and foremost an orphanage and a mission’s base. It is important for us as missionaries, to represent Christ well. Missionaries carry the gospel message through their words and actions. We must do our best to avoid the appearance of evil so as not to become a stumbling block for others. Missionaries must understand that they are constantly being observed and evaluated by the children, Honduran employees and members of the surrounding community. Certain actions and behaviors considered harmless, “no big deal” or normal within the context of your own culture might be quite offensive or even destructive here. Please keep in mind that serving as a missionary at the City of Refuge means that you represent IMI and not just yourself. This becomes even more important in the case of younger missionaries who may be the same age or just a few years older than some of our children. Please refrain from flirting and or engaging in any physical affection with the opposite sex unless you are married. This includes holding hands, hugging, laying together or entering sleeping quarters of the opposite sex as that portrays a very different view in the Honduran culture than it does in your own homeland. We do not allow unmarried missionaries and interns to be anywhere secluded alone with someone of the opposite sex. Failure to respect these guidelines and or stand corrected may result in a missionary being immediately sent home at their own expense and being banned from future visits to the City of Refuge. In addition, City of Refuge employees are prohibited from fraternizing with the opposite sex as a condition of their employment. This includes exchanging phone numbers or other forms of electronic communication not directly related to their normal job duties. Please help them by respecting this boundary.

Release of Liability to Impact Ministries International & Responsibility of Traveler

Impact Ministries International (IMI), its Board, agents, servants, and missionaries, hereinafter IMI, acts only as an agent for the Traveler in connection with all aspects of traveler trip and it is understood and agreed that IMI assumes no liability for injury, damage, loss accident, medical expenses, delay or irregularity which may be occasioned for any reason whatsoever, due to its own acts or omissions or through the acts or omissions of any company or person engaged by IMI for the purpose of, transporting or housing Traveler, or in carrying out the arrangements of the trip, and IMI accepts no liability or responsibility for losses or additional expenses due to delay or changes in air or other services, sickness, weather, strike, war, quarantine, or other causes. The right is reserved to IMI to substitute living accommodations of similar quality to those specified in the itinerary and to cancel any trip prior to departure, in which latter case a full refund will constitute full settlement to Traveler. No refund will be made for any unused portion of the trip unless arrangements are made prior to departure from the United States.

As a Christian organization, our witness is very important. The use of illegal drugs, alcohol, or tobacco products is strictly prohibited throughout the trip. No form of abuse and/or sexual harassment of any kind will be tolerated. Appropriate action will be taken in every situation. IMI reserves the right to send any team member home at their own expense, if there is an infraction of the rules or if deemed necessary by IMI’s Trip Leader in order to protect the safety, witness and work of the ministry within the country. You will be responsible for any costs incurred by your actions. Thank you for your courtesy and cooperation with IMI’s rules and the local customs of the country.

For good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, I hereby grant to Impact Ministries International (IMI) and its ministries, auxiliaries, affiliates, licensees, successors and assigns IMI, all rights of every kind, in connection with the Project, to photograph and record me in still, audio and/or video format, and in perpetuity to own, use, exploit, sell, distribute, broadcast, and edit in any manner in any and all media now known or hereafter devised, my performance, image, character(s), portrayal(s), likeness or appearance; my name and voice; music (subject to third party licensing), sound effects, dialog or other material created by me in the course of my appearance, and the results and proceeds thereof (the "Performance") in and in connection with the production, distribution, licensing, advertising, sales, publicizing, and other exploitation of materials arising from my Performance, and any other forms or formats of media, whether now known or hereafter developed (the “Media”), in which the same may be used or incorporated at IMI's sole discretion. I acknowledge that IMI shall own all rights in and to the results and proceeds of my Performance and the Media (collectively, the “Materials”), including without limitation the copyright therein, such Materials being work(s)-for-hire under US copyright law and analogous laws of other countries. In the event the Materials, or any parts thereof, are not deemed work(s)- for-hire, I hereby irrevocably assign to IMI any and all right, title and interest (including copyright) in and to the Materials, in all media now known or hereafter devised, in perpetuity throughout the universe. I expressly release IMI and its agents and attorneys from, and agree not to sue in law or equity for, any and all claims I have or may have for defamation, invasion of privacy, personality or publicity, or any other cause of action arising out of or in connection with the production, distribution or exhibition of the Materials, or the exercise of any right granted herein. This release does not transfer the copyright in any sermon, song, choreography, artwork, or other underlying copyright-able material, to IMI, unless IMI has specifically commissioned the creation of a new sermon, song, choreography, artwork, or other underlying copyright-able material in connection with my Performance.