Poetice

Missions Retreat Application

IDENTITY

* First Name

* Last Name

* Email

* Preferred Name

* Address

* City

* State

* Postal Code

* Country

* Phone

* Gender

* Birthday

Please select your birthday from the date picker or manually format your birthday MM/DD/YYYY

SPIRITUAL

* In 2-3 sentences, tell us about when you gave Jesus permission to be Lord of your life. If you haven't done so or you are unsure, please share where you are currently at with God.

* What do you love about God, and how do you best relate with Him?

* What do you desire to learn about God and how would you like to grow in your relationship with Him?

* Are there any challenges or obstacles you are facing in your life that you would like to share with us?

* Please list any of your talents, abilities, giftings, preferences, etc., that you would love to offer or contribute during this Missions Retreat.

TRAVEL PREFERENCES

* What group are you applying with? Please type the full name of the church, school, etc., that you are traveling with. If you are traveling as an individual, please write 'individual'. Ex: Hope College, The Ransom Church, etc.

* List two or more airports you would be willing to depart from. Please provide the airport names and three (3) character codes like this: Grand Rapids (GRR), Detroit (DTW), Chicago Ohare (ORD)

BASIC MEDICAL INFORMATION

While a complete physical is not required for participation in this retreat, it is encouraged. It is our hope and your responsibility to ensure your physical condition is satisfactory for participation in this retreat.

I understand that it is solely my responsibility to complete a physical exam and or ensure that my physical condition is satisfactory for participation in this type of work.

* Please list all medical or dietary allergies, conditions, and or restrictions that you have. This list should include vegetarian or gluten-free, nut or penicillin allergy, etc. (If none, simply indicate "none")

* Please list all medications that you are currently taking or will be taking during your time in our Missisons Retreat. (If none, simply indicate "none.")

* Please select your blood type

UPLOADS

WAVIER & RELEASE FORM
Please upload a scan of your signed Wavier & Release Form (find the link under the DOWNLOADS section)

* Waiver

PASSPORT
Please upload a photo of your passport. If you have not yet received your passport, please email it to travel@poetice.org as soon as possible. (*file must be less than 1MB in size)

Passport

Please list your name as it appears on your passport.

PASSPORT EXPIRATION DATE

IMMUNIZATION RECORDS

Please visit the Center for Disease Control (CDC) website to review all necessary immunizations for Zambia. If your immunizations are up-to-date, please upload a copy of your immunization records.

If your immunizations are not up-to-date, please upload a copy of your record to https://poetice.org/upload once you have received the recommended immunizations.

Immunization Record

EMERGENCY CONTACT

* Emergency Contact

* Emergency Phone

* Emergency Contact Email Address

AGREEMENTS & OBLIGATIONS

(1) I UNDERSTAND that I am responsible for my airfare and any other retreat costs as communicated to me by Poetice, as well as obtaining a passport and necessary immunizations, completing a waiver release form, providing up-to-date immunization records, and adhering to Poetice deadlines.

I UNDERSTAND.

(2) I UNDERSTAND that if I do not raise and submit the necessary funds by the final due date, my flight will be canceled, and I cannot participate in the Missions Retreat.

I UNDERSTAND AND AGREE TO THESE TERMS.

(3) I UNDERSTAND that should I withdraw from this retreat for any reason, I am still responsible for any expenses that have already been incurred on my behalf by the date of my withdrawal. Because funds cannot be returned for any reason, any remaining donated funds on my behalf will be disbursed to other retreat participants or programs at the discretion of Poetice within Poetice's current fiscal year.

I UNDERSTAND AND AGREE TO FOLLOW THROUGH ON MY COMMITMENT FULLY.

(4) I UNDERSTAND that all donations given to Poetice by me or on my behalf are non-refundable, non-transferable, and can NOT be returned in any form for any reason. I acknowledge that should I be unable to participate for any reason, all funds raised on my behalf will be used for the retreat service projects, applied to local scholarships, or distributed to any other Poetice activity at the discretion of the Poetice Leadership Team. I further understand that should I raise more funds than are necessary to fully cover the cost of my retreat, overage funding will be dispersed to other retreat participants or programs at the discretion of Poetice Leadership.

I AGREE.

CONFIRMATION OF IDENTITY AND TRUTHFUL INFORMATION

I CONFIRM THAT I AM FILLING THIS APPLICATION OUT FOR MYSELF, NOT FOR SOMEONE ELSE, AND THAT ALL INFORMATION I HAVE PROVIDED ON THIS FORM IS CORRECT TO THE BEST OF MY KNOWLEDGE.

IMPORTANT INFORMATION

There is no greater responsibility and opportunity than stewarding your soul. We believe in doing the work, taking the risk, and spending the time, energy, and money to steward your own life and relationship with Jesus. No matter where you are with God, there is always more to receive and more to learn. We desire to create moments and spaces for you to do just that as you come alongside our team and community.

We are looking for participants who desire to encounter Jesus in fresh ways, grow and learn new things, and work this out while you join the Poetice mission to serve and love our city.

We desire to know our Missions Retreat participants deeply. The questions on this application are intended to help us get to know you better and to help us understand what you are hoping and believing for while you are with us.

Please keep in mind that you cannot save this application once you start it, so be sure to complete and scan any necessary uploads BEFORE starting your application.