2014 Application Package
2014 Tampa Deanery Dominican Mission Project Iglesia Santa Cruz Application Package
Contains: 1. Application Form 2. Missionaries’ Statement 3. Missionary Obligation 4. Parental Consent Form (Minors Only) Please Note: The Missionaries’ statement must be notarized.
Name
Team
Application Form
2014 Tampa Deanery Dominican Mission Project Santa Cruz Santa Fe, Dominican Republic Overview
The Tampa Deanery’s 2014 project is to complete the entire exterior and first floor shell of the new 2 story church building for the Santa Cruz mission. It is in a poor suburb of San Pedro called Santa Fe. The Santa Cruz project is an undertaking of the Tampa deanery in cooperation with the community of Santa Fe, and congregation of the Dominican Episcopal Church. Team members will work WITH Dominicans in the construction of this new facility, sharing life and spirituality with brothers and sisters in Christ from the Dominican Republic. The cost per person is $1800 as this is used for room and board and to purchase construction material for the project. A non-refundable fee of $200.00 is required with the application. Following acceptance as a member of the Santa Cruz project, team members are expected to help in fund raising, and to participate in regular team meetings in preparation for going on a 2014 work team. Participants will receive detailed information about working in a cross-cultural setting, and about transportation, lodging, and what to take, etc. If you do not have a passport, you must apply for you right away. You may obtain a passport application form at select Post Offices. Your name on this application should be the same as it appears on your passport. Personal Information Name:______________________________________________ (As it appears on your Passport) Last First Middle Address: ___________________________________________________________________ E-mail:
____________________________________
Telephone:
Daytime ____________________
Church: _____________________________
Evening ____________________ Priest ______________________
How long have you attended? _______ Are you a member? ______ Date of Birth: ____/ ____/ ____ Age_______
Marital Status Single Married
American Airlines Advantage #________ Passport issue/expiration date_________/_________ Passport Number ___________________(If you do not have a passport you must apply for one immediately) Contact name & tel. number for when you are abroad Name____________________________Relationship__________Phone (_____)____-______ Which Weeks are you interested in?
____________ June 7-14
____________ June 14-21
__________ June 21-28
___________ July 5-12
Give name and telephone number of two references (including your priest):
Skills (Teams will help build the reinforced concrete Santa Cruz church building, and thus will work in related areas. Team members need not be accomplished builders but must be at least willing “gofers.”) 1. Please list the skills you can bring to this project (carpentry, masonry, plumbing, electrical, etc.), and at what skill level (professional builder, handyman, willing learner (i.e. willing to mix cement), “gofer,” etc.) Please note you do not need to be skilled nor a tradesperson to participate.
2. Do you speak Spanish? If so, at what level would you rate your ability ( 1 being very limited, 5 being relatively fluent.)?______ Personal Spiritual Journey Team members of the San Cruz Project will serve as short term missionaries for the week they are in the Dominican Republic. Please respond to the following as part of your application. 1. Describe your spiritual journey.
2. What are your primary spiritual gifts and strengths?
3. What roll do you see yourself fulfilling as part of this mission trip?
4. Are you willing to raise or contribute personally financial support necessary for your participation in the Mission project? For Additional Information or questions about this form or the project please call or Email . Bill Kunkle Sally Thompson
813-310-0267 Email: [email protected] 813-254-3009 Email: [email protected]
Tampa Deanery Project Santa Cruz Mission - Summer 2014 Santa Fe, Dominican Republic Missionaries Statement
I, ___________________________________, agree not to hold any Episcopal Church, the Diocese of Southwest Florida, or the Dominican Development Group, its officers, employees, or other agents liable for any injury, loss, damage, or accident that I might encounter while on the mission project. I realize and acknowledge that my participation on this mission trip to the Dominican Republic includes many risks and possible dangers. I am well aware that my travel to the Dominican Republic exposes me to many known and unknown risks including accidents, disease, war, political unrest, injury, little or no medical care, and other calamities. I hereby assume any and all risks that might result from my travel to and from, and my stay in, the Dominican Republic, and I unconditionally agree to hold any Episcopal Church, the Diocese of Southwest Florida, and the Dominican Development Group, its officers, employees, or other agents harmless from any liability concerning my personal health and well-being, or any liability for my personal property that might be lost, damaged or stolen while on this mission trip. I have carefully read the foregoing and I understand that my signature herein holds any Episcopal Church, the Diocese of Southwest Florida, and the Dominican Development Group, its officers, employees, or other agents harmless for any liability for injury, damage, loss, accident, delay or irregularity in schedule. Date: _______________ __________________________________
____________________________________ Signature
__________________________________ Witnesses STATE OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing instrument was acknowledged before me this ____ day of _____________, 2014, by _____________________________________, who is personally known to me or who has produced ___________________________ as identification and who did take an oath. ____________________________________ NOTARY PUBLIC, STATE OF FLORIDA Print Name: _________________________ My Commission Expires: _______________
2014 Tampa Deanery Dominican Mission Project Iglesia Santa Cruz Santa Fe, Dominican Republic Dominican Episcopal Church
Missioner's Obligation
I,_________________________, hereby agree as a follower of Jesus Christ, to participate on team__________ . I also agree to fund raise to the best of my ability understanding I am responsible for raising the funds required for my participation in this mission, and that if for any reason I have to drop out of the Santa Cruz project after the airline tickets are purchased, I am morally responsible for paying for the designated airfare for this trip or for finding a replacement for me who is acceptable and approved by the mission coordinating committee.
___________________________ Signature
_____________ Date
2014 Tampa Deanery Dominican Mission Project Iglesia Santa Cruz Santa Fe, Dominican Republic Permission to Remove Minor Child to the Dominican Republic I / we authorize _________________________________________ to take my minor child, _____________________________________ on a mission trip from the United States to the Dominican Republic from _______________ to _______________, 2014. _____________________________________ may act in my place “in loco parentis” for all matters including medical treatment in the event of sickness or injury. __________________________________ Signature of Parent or Guardian
___________________ Date
STATE OF FLORIDA COUNTY OF _____________________
The foregoing instrument was acknowledged before me this ____ day of _____________, 2014, by _____________________________________, who is personally known to me or who has produced ___________________________ as identification and who did take an oath. __________________________________ NOTARY PUBLIC, STATE OF FLORIDA
Contains: 1. Application Form 2. Missionaries’ Statement 3. Missionary Obligation 4. Parental Consent Form (Minors Only) Please Note: The Missionaries’ statement must be notarized.
Name
Team
Application Form
2014 Tampa Deanery Dominican Mission Project Santa Cruz Santa Fe, Dominican Republic Overview
The Tampa Deanery’s 2014 project is to complete the entire exterior and first floor shell of the new 2 story church building for the Santa Cruz mission. It is in a poor suburb of San Pedro called Santa Fe. The Santa Cruz project is an undertaking of the Tampa deanery in cooperation with the community of Santa Fe, and congregation of the Dominican Episcopal Church. Team members will work WITH Dominicans in the construction of this new facility, sharing life and spirituality with brothers and sisters in Christ from the Dominican Republic. The cost per person is $1800 as this is used for room and board and to purchase construction material for the project. A non-refundable fee of $200.00 is required with the application. Following acceptance as a member of the Santa Cruz project, team members are expected to help in fund raising, and to participate in regular team meetings in preparation for going on a 2014 work team. Participants will receive detailed information about working in a cross-cultural setting, and about transportation, lodging, and what to take, etc. If you do not have a passport, you must apply for you right away. You may obtain a passport application form at select Post Offices. Your name on this application should be the same as it appears on your passport. Personal Information Name:______________________________________________ (As it appears on your Passport) Last First Middle Address: ___________________________________________________________________ E-mail:
____________________________________
Telephone:
Daytime ____________________
Church: _____________________________
Evening ____________________ Priest ______________________
How long have you attended? _______ Are you a member? ______ Date of Birth: ____/ ____/ ____ Age_______
Marital Status Single Married
American Airlines Advantage #________ Passport issue/expiration date_________/_________ Passport Number ___________________(If you do not have a passport you must apply for one immediately) Contact name & tel. number for when you are abroad Name____________________________Relationship__________Phone (_____)____-______ Which Weeks are you interested in?
____________ June 7-14
____________ June 14-21
__________ June 21-28
___________ July 5-12
Give name and telephone number of two references (including your priest):
Skills (Teams will help build the reinforced concrete Santa Cruz church building, and thus will work in related areas. Team members need not be accomplished builders but must be at least willing “gofers.”) 1. Please list the skills you can bring to this project (carpentry, masonry, plumbing, electrical, etc.), and at what skill level (professional builder, handyman, willing learner (i.e. willing to mix cement), “gofer,” etc.) Please note you do not need to be skilled nor a tradesperson to participate.
2. Do you speak Spanish? If so, at what level would you rate your ability ( 1 being very limited, 5 being relatively fluent.)?______ Personal Spiritual Journey Team members of the San Cruz Project will serve as short term missionaries for the week they are in the Dominican Republic. Please respond to the following as part of your application. 1. Describe your spiritual journey.
2. What are your primary spiritual gifts and strengths?
3. What roll do you see yourself fulfilling as part of this mission trip?
4. Are you willing to raise or contribute personally financial support necessary for your participation in the Mission project? For Additional Information or questions about this form or the project please call or Email . Bill Kunkle Sally Thompson
813-310-0267 Email: [email protected] 813-254-3009 Email: [email protected]
Tampa Deanery Project Santa Cruz Mission - Summer 2014 Santa Fe, Dominican Republic Missionaries Statement
I, ___________________________________, agree not to hold any Episcopal Church, the Diocese of Southwest Florida, or the Dominican Development Group, its officers, employees, or other agents liable for any injury, loss, damage, or accident that I might encounter while on the mission project. I realize and acknowledge that my participation on this mission trip to the Dominican Republic includes many risks and possible dangers. I am well aware that my travel to the Dominican Republic exposes me to many known and unknown risks including accidents, disease, war, political unrest, injury, little or no medical care, and other calamities. I hereby assume any and all risks that might result from my travel to and from, and my stay in, the Dominican Republic, and I unconditionally agree to hold any Episcopal Church, the Diocese of Southwest Florida, and the Dominican Development Group, its officers, employees, or other agents harmless from any liability concerning my personal health and well-being, or any liability for my personal property that might be lost, damaged or stolen while on this mission trip. I have carefully read the foregoing and I understand that my signature herein holds any Episcopal Church, the Diocese of Southwest Florida, and the Dominican Development Group, its officers, employees, or other agents harmless for any liability for injury, damage, loss, accident, delay or irregularity in schedule. Date: _______________ __________________________________
____________________________________ Signature
__________________________________ Witnesses STATE OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing instrument was acknowledged before me this ____ day of _____________, 2014, by _____________________________________, who is personally known to me or who has produced ___________________________ as identification and who did take an oath. ____________________________________ NOTARY PUBLIC, STATE OF FLORIDA Print Name: _________________________ My Commission Expires: _______________
2014 Tampa Deanery Dominican Mission Project Iglesia Santa Cruz Santa Fe, Dominican Republic Dominican Episcopal Church
Missioner's Obligation
I,_________________________, hereby agree as a follower of Jesus Christ, to participate on team__________ . I also agree to fund raise to the best of my ability understanding I am responsible for raising the funds required for my participation in this mission, and that if for any reason I have to drop out of the Santa Cruz project after the airline tickets are purchased, I am morally responsible for paying for the designated airfare for this trip or for finding a replacement for me who is acceptable and approved by the mission coordinating committee.
___________________________ Signature
_____________ Date
2014 Tampa Deanery Dominican Mission Project Iglesia Santa Cruz Santa Fe, Dominican Republic Permission to Remove Minor Child to the Dominican Republic I / we authorize _________________________________________ to take my minor child, _____________________________________ on a mission trip from the United States to the Dominican Republic from _______________ to _______________, 2014. _____________________________________ may act in my place “in loco parentis” for all matters including medical treatment in the event of sickness or injury. __________________________________ Signature of Parent or Guardian
___________________ Date
STATE OF FLORIDA COUNTY OF _____________________
The foregoing instrument was acknowledged before me this ____ day of _____________, 2014, by _____________________________________, who is personally known to me or who has produced ___________________________ as identification and who did take an oath. __________________________________ NOTARY PUBLIC, STATE OF FLORIDA
