Mission Trip Registration

Youth - Summer 2024 - Waco 2024


*DEPOSITS AND ALL PAYMENTS ARE TAX-DEDUCTIBLE AND NONREFUNDABLE.

*Scholarships are available. Contact Megan Hulings for more information.

Please fill out information below with PARTICIPANT'S Information.
6/27/2024 - 6/30/2024
$325.00
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Additional Information

This is the registration for the Waco 2024 MDPC Youth middle school mission trip for current 5th (class of 2031) and 6th (class of 2030) graders. We will be partnering with Mission Waco in Waco, TX. For more information on Mission Waco, visit https://missionwaco.org/

  • Who: CURRENT 5th (class of 2031) and 6th (class of 2030) Graders
  • When: Thursday, June 27, 2024 - Sunday, June 30, 2024
  • Total cost: $325
    • Deposit - $100 (a payment link will be sent to you within 2 business days of registration)
    • 2nd payment (Feb 16) - $100
    • Final payment (April 1) - $125

WHAT TO EXPECT WHEN FILLING OUT THIS REGISTRATION:

Please allow at least 30 minutes to complete the entire registration.
Both the student/participant and parent/guardian need to be present.

SECTION 1
Student/participant's information to be filled out by the parent/guardian.

SECTION 2
Student/participant's medical information to be filled out by the parent/guardian.

SECTION 3
Spiritual questions that need to be filled out by the student/participant

SECTION 4
Consent and release information to be read and agreed upon by both the student/participant AND parent/guardian.

SECTION 1: to be completed by the PARENT/GUARDIAN

Before proceeding with the registration, please understand that this is a mission trip meaning that ALL payments made towards this trip are NON-REFUNDABLE and are tax-deductible.

*

By clicking YES, I am acknowledging that my student will attend the Waco mission trip from START to FINISH. For the safety of our students, the MDPC Youth's mission trip is too large to accommodate late arrivals or early pick-ups for any reason, including but not limited to: sporting events, others camps, vacations, school events, etc.

*

By checking this box, I agree to not send my child with his or her cell phone or other similar electronic devices.

Please copy and paste the following link in your web browser to be directed to Mission Waco's liability form. Please complete the document and email it to mhulings@mdpc.org. Once you have completed that form, you can return to this page to complete the application.

Click Here for the Form

SECTION 1: to be completed by the PARENT/GUARDIAN

*PARTICIPANT'S first name:
*PARTICIPANT'S last name:
PARTICIPANT'S nickname:
*PARTICIPANT'S date of birth:
*PARTICIPANT'S gender:
*PARTICIPANT'S congregation:
*PARTICIPANT'S cell phone:
*PARTICIPANT'S email (school email is fine):
*PARTICIPANT'S current grade:
*PARTICIPANT'S current school:
*PARTICIPANT'S t-shirt size:

(optional) Please list your top 3 friends to be placed in the same Family Group. There Is NO GUARANTEE and we will do our best to place you with at least ONE of the friends you have listed. Family groups are final.

SECTION 2: to be completed by the PARENT/GUARDIAN

*CONSENT FOR MEDICAL TREATMENT
The undersigned does hereby give permission for a youth leader or adult chaperone, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the Participant.

The undersigned does hereby acknowledge that if it is my responsibility to notify IN WRITING MDPC Youth Ministry of any changes regarding the Participant’s health, medications, or medical insurance.

The undersigned does hereby acknowledge that should it be necessary for the Participant to return home for a medical reason, the undersigned shall assume all transportation costs and responsibility.
*Does the Participant have any food, drug, or other allergies?  If none, please state "none."
*Does the Participant require an EpiPen for one or more of these allergies?
*If yes, the undersigned does hereby acknowledge that he/she must send two (2) EpiPens with the Participant, one (1) to be kept on his/her person and one (1) to be kept by his/her group leader.
*Does Participant require an inhaler for one or more of these allergies?
*If yes, the undersigned does hereby acknowledge that the Participant may carry his/her inhaler according to the physician/parent statements and that he/she will comply with the following conditions: 1) Participant is aware of the correct use of the inhaler, 2) Participant agrees to never share the inhaler with another person, and 3) Participant agrees that after taking the initial dose prescribed, if there is not marked improvement, he/she will go immediately to an adult leader. 

If necessary, I also grant permission for an adult volunteer or staff to administer medication to my child according to the statement above.
*Does Participant have any underlying or chronic health/physical conditions or limitations youth staff/leadership should be aware of?  If none, please state "none."
*Is the Participant current on all required vaccinations
*PRESCRIPTION MEDICATION POLICY:
The undersigned does hereby acknowledge that the Participant is required to give ANY PRESCRIPTION MEDICATION to the trip leader in its original container and with complete dispensing instructions before the start of the event.
*Will this Participant require any prescription medications drugs during this Activity?
*If yes, do you give permission for a youth leader or adult chaperone to administer the Participant the prescription medications listed below as directed on the label during this Activity?
If you have answered yes to the two preceding questions, please know you will receive a separate email for additional information.
*OVER THE COUNTER MEDICATION POLICY
The undersigned does hereby acknowledge that the Participant is required to give ANY OTC MEDICATION (including vitamins, herbal supplements, Accutane or other non-topical acne medicines, birth control pills, all medications listed below, etc.) to the trip leader in its original container and with complete dispensing instructions before the start of the event. For your convenience, the trip leader carries a basic first aid kit for all trips which includes common OTC medications such as Tylenol, Advil, Excedrin, Sudafed, NyQuil, Benadryl, Mucinex, Gas-X, Pepto Bismol, and Imodium.   

I acknowledge that my Participant is not permitted to carry any OTC medication, herbal supplement, or vitamin.
*OTC MEDICATION ADMINISTRATION CONSENT
Do you give permission for the Participant to be given over-the-counter medication as needed and as directed on the label, to treat non-emergency medical conditions that do not require a doctor or hospital visit such as a minor headache, stomachache, or allergic reaction (i.e. Tylenol, Advil, antacids, Benadryl) during this Activity?
*Please list any OTC medications Participant takes on a regular basis and will bring on the trip.  Please know you will receive an email requesting dosage, how often and the reason for taking the medication.  If none, please state "none."
*MEDICAL INSURANCE INFORMATION:
Medical Insurance Company (if self-insured or uninsured, state so below)
*Insurance Company Customer Service Phone Number
*Name of Insured (Primary Policy Holder)
*Date of Birth of the Insured (Primary Policy Holder)
*Policy Number
*Group Number
*Rx ID Number
*Rx Group Number
*EMERGENCY CONTACT INFORMATION:
Emergency Contact
*Emergency Contact's Phone Number
*Emergency Contact's Relationship to Participant

SECTION 3: to be completed by the STUDENT/PARTICIPANT

*

By checking this box, you agree that the STUDENT/PARTICIPANT is filling out SECTION 4

*1. Have you been on an MDPC mission trip before? If yes, which one(s)?
*2. Have you ever served at MDPC before? Maybe at Fuente Food Pantry, Kids Meals, Church in The City, etc. If yes, where have you served?
*3. Why do you want to come on this trip?

4. Share a time when God showed up in your life.

*

5. Why as followers of Jesus is it important to love and serve others?

SECTION 4: to be completed by both the STUDENT/PARTICIPANT and PARENT/GUARDIAN

*GENERAL CONSENT
The undersigned does hereby give permission for the above-named youth (“Participant”), to attend and participate in the Memorial Drive Presbyterian Church (“MDPC”) Youth Ministry activity, event, or retreat for which this registration applies (“Activity”).
*LIABILITY RELEASE 
The undersigned does hereby release, forever discharge and agree to hold harmless MDPC, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in this Activity. I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in this Activity. I agree to hold harmless and indemnify MDPC for any liability sustained by MDPC as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

The undersigned does hereby acknowledge that if I desire to limit the activity of this Participant in this Activity that it is my responsibility to submit IN WRITING such wishes to the Youth Director at least 24 hours in advance.
*TRANSPORTATION RELEASE
The undersigned does hereby give permission for the above-named youth to ride in any vehicle driven by an approved and licensed youth leader or adult chaperone AND/OR any church-provided transportation (buses, planes, boats, etc.). 

The Participant and I understand that a SEAT BELT MUST BE WORN AT ALL TIMES during transportation.
*CONTACT WITH YOUTH
The undersigned does hereby give permission for MDPC youth staff and volunteers to contact the Participant outside of this Activity for ministry purposes through text message and social media.

The undersigned does hereby acknowledge that if I desire to limit the MDPC youth staff and volunteers contact with this Participant outside of this Activity, it is my responsibility to submit IN WRITING such wishes to the Youth Director.

The undersigned does hereby acknowledge that MDPC youth staff and volunteers have completed Child Protective Training and a criminal background check prior to his/her involvement with youth.  MDPC invites into ministry only those adults who have no previous convictions for sexual or physical abuse or any adults who do not conform to the standards of our reference and screening processes.

COVENANT OF COMMUNITY EXPECTIONS (please read in full)

MDPC Youth Ministries Mission Trips serve the purpose of encouraging students to grow in their knowledge and relationship with Jesus by serving others. MDPC Mission Trips are challenging and students are expected to meet the high standards of behavior listed below in addition to following the directions of all adult leaders with regards to participation and engagement.

  • Participant will be present at and fully engaged in this trip and its projects, programs and meetings.
  • Participant will be respectful, encouraging, and always strive towards maintaining a positive attitude toward others, recognizing Christ's presence in each other.
  • Participant will avoid the use of foul language.
  • Participant will listen to and follow the direction of the adult leaders, whose care they are under.
*

If a student is repeatedly unable to meet the standard of behavior, parents will be brought into the conversation to help assist leaders in enforcing expectations. By clicking yes, you agree to participating in those conversations if necessary and helping to uphold the standard of behavior with regards to this trip. You are also agreeing to talk with your student prior to the trip regarding the expectations.

ZERO TOLERANCE POLICIES (please read in full)

If a student violates one and/or all zero-tolerance policies, students will be subject to disciplinary action and parents/guardians will be asked to arrange for their student to be sent home immediately at the discretion of the Next Gen Pastor (Rachel Poysky) and Director of Youth Ministry (Amanda Shockley). Zero tolerance policies refer to the boundaries detailed below. Parents/guardians are responsible for all transportation costs associated.

By checking each box, the parents/guardians and student acknowledge that they have read the policies and agree to be subject to the disciplinary action taken should these policies be violated:

*

Participant will not smoke, vape, drink or use illicit drugs or bring paraphernalia associated with those acts.

    *

    Participant will not use racist or sexually explicit language (including about or toward another participant or leader on the trip).

      *

      Participant will not bring weapons of any kind (hunting knives, pocket knives, laser pointers, lighters etc.)

        *

        Participant will treat all other leaders and students respectfully, not engaging in bullying by isolation, teasing or pranks that cause harm.

          *EARLY RETURN HOME POLICY
          The undersigned does hereby acknowledge that should it be necessary for my child or youth to return home due to medical reasons, disciplinary action, or otherwise, the undersigned shall assume all transportation costs and responsibility.
          *PHOTO RELEASE
          The undersigned does hereby give permission for the above-named youth to be photographed and recorded during this Activity.  I grant MDPC permission to use and publish images taken. 
          *I am the parent / guardian of the above-named child and I have legal capacity to sign this release
          *

          First & Last Name of Parent/Guardian Agreeing to Terms & Conditions Above

          *Date of Birth of Parent/Guardian Agreeing to Terms & Conditions
          *Parent/Guardian Preferred Cell Phone (NOTE THAT THIS PHONE NUMBER WILL BE USED FOR ALL TEXT & PHONE CORRESPONDENCE PERTAINING TO THIS ACTIVITY/EVENT.)
          *Parent/Guardian Preferred Email (NOTE THAT THIS EMAIL ADDRESS WILL BE USED FOR ALL CORRESPONDENCE PERTAINING TO THIS ACTIVITY/EVENT.)
          *I understand and agree that there will NO REFUNDS issued.
          *I understand and agree that there will be NO EARLY DROP-OFF or PICK-UP.

          You will receive a separate payment link to pay your deposit via email within 2 business days of completing this form.

          PLEASE READ: When you have completed this form and hit "Apply," this page will refresh, show you a green box with a checkmark (indicating that your registration went through) and allow you to register another student if needed.