SHORT TERM PROJECT AGREEMENT           Lighthouse Community Church, P.O. Box 325 Fort Worth, Tx 76101

Cross Culture Experiences, Inc./Mission Waco                                   Phone: 817-846-9881   

(Must be returned to guarantee reservation                                                  Email:  mhatcher@1lighthousechurch.com

 

We, __________________________________________, do hereby agree with Lighthouse Community Church, to attend the following Short Term Project:

•Day/Date (i.e. Saturday, Feb. 17, 2001): __________________________________________________

•Group will arrive at the designated work site at: _______________________a.m. / p.m.

•Group needs to complete work and be ready to depart at: ____________________________a.m. / p.m.

•PLEASE NOTE:  Meals are not provided – please make your own arrangements. 

Estimated Group Size:   Adults ______College Students ______Youth ______

(1 adult sponsor needed per 7-8 high school youth or 5-7 junior high youth)

We will contact Lighthouse Community Church three (3) working days prior to our arrival date to confirm final numbers, arrangements and inclement weather plans. We agree to be responsible for our own group’s behavior, to select members who can adequately grow and be challenged from such an experience, bring all Release of Liability/Parent Permission Forms for all participants, including parent signature for participants under 18.

_____________________________________________________________________

Authorized Group Leader      DateCCE/Mission Waco Rep.Date

Leader Name (Printed) ________________________________________ Email _________________________

Group Name _______________________________________________________________________________

Mailing Address _____________________________City ______________________ State ____   Zip _______

Day Phone _________________  Evening Phone ______________________  Cell Phone _________________

SERVICE PROJECT PREFERENCES

Note:  While we will try to accommodate your preferences, project assignments are made based on ministry or program need.  Please communicate to your group the need to be flexible.  Thank you!

Please check the projects that you think best fit your groups’ skills/attention/maturity:

_____  Paint*   _____  Construction* (little/no experience)   _____  Mow/Weedeat*

_____  Caulk/Scrap paint*_____  Construction* (moderate experience)_____  Trash Pickup*

_____  Donation pickups* _____  Construction* (heavy experience)     _____  Mop/Sweep/Dust

_____  Shelve items at retail store   _____  Fold/Label Newsletter       _____  Clean windows

_____  Sort/hang clothing _____  Help w/children’s activities              _____  Help w/teen activities

_____  Provide meal _____  Help w/toy store (Nov/Dec) or school supplies store (July/Aug)

_____  Heavy labor/lifting* (breaking up big wooden crates with sledgehammers/crowbars, or other work)

* For projects marked with asterisk, please ask your group members to bring their own work gloves.

SPECIAL NEEDSDOES YOUR GROUP HAVE INTEREST IN:

Please indicate any special needs of your group:_____  One of our staff leading a short teaching/

________________________________________    discussion time during your visit on an inner

________________________________________            city issue (i.e. poverty, social justice, etc.)

  _____  Info on our weekend Poverty Simulation

  _____  Volunteer Orientation (required for those

OFFICE USE ONLY                                    volunteering on a regular basis)

Staff Member Assigned: _______________                     Confirmed: _______________

Group Leader Contacted: ______________Arrangements Confirmed: _______________

Comments:

BACKGROUND CHECKS WILL BE DONE ON ALL PARTICIPANTS

RELEASE OF LIABILITY AND PARENT PERMISSION FORM

Lighhouse Community Church

(And as applicable for joint projects with other agencies, organization or churches)

Required for the following activities:  Check all that apply for this release.

___ BOOT CAMP Poverty Simulation, Fort Worth, TX

___ Out of Country Mission/Exposure Trip:  Specific which country - ____________________

___ Special Outing or Field Trip:  Describe _________________________________________

___ Lighthouse Program(s) including transportation:  Describe _______________________

___Volunteerism in Lighthouse programs

___Construction/Work Projects

Whereas, the undersigned participant wishes to be accepted for participation in one or more of the activities listed above which is organized by Lighthouse Community Church of Fort Worth, TX and action in allowing the applicant to participate in such activities or programs, the undersigned acknowledges that the activity does involve certain risks.  The activities are designed to allow the participant to broaden their understanding of various Christian values, socio-economic differences, ethnic and racial diversity, cultural appreciation, team building, character development, and/or enrichment opportunities.  These activities include those listed above, but are not limited to, and activities in a lower income neighborhood and among poor people in Fort Worth, TX, other communities, and foreign countries.  I understand that participants are exposed to physical and psychological risk through elements of nature, travel by car, van, plane, walking, or other conveyance, and direct contact with people from various backgrounds.  Risks may also include damage or loss of personal property.  Risks may also include physical injury and/or strenuous physical activity at work/construction sites.  I further understand that immediate medical treatment may be difficult or delayed, especially in foreign countries. 

In consideration of the above, I have and do hereby assume all the above risks and any other ordinary risk incidental to the nature of the program, including risks which are not specifically foreseeable, and will hold harmless and indemnify Lighthouse Community Church, its Board of Directors, employees, agents, and/or Associates The terms hereof, and my signature on this document shall serve as a release and assumption of risk, and shall bind my heirs, representatives, executors, administrators, successors and assigns and for all members of my family, including any minors accompanying me.  I also state that I am not under, and will not be under the influence of any non-prescribed chemical substance, including alcohol.  I also state that I will assume responsibility for any damage or loss to physical property or expenses incurred due to negligent or irresponsible behavior.  I understand that my participation in this Lighthouse Community Church  program or activity is entirely VOLUNTARY.

My signature also gives my permission and accepts financial responsibility, as well, for first aid treatment and/or professional medical attention if needed.  I also give permission for photographing of myself or my child during the activities and use of those pictures or video by Lighthouse Community Church.

_________________________________________________________________________________

PARTICIPANT SIGNATURE          DATEWITNESSDATE

_________________________________________________________________________________

PARENT/GUARDIAN  SIGNATUREDATEWITNESSDATE

FOR ANY PARTICIPANT UNDER AGE 18

Please print legibly – Each participant must complete this section:

Participant Name: ______________________________Age: ______________Phone: (           )____________

Address:_____________________________________City: ______________Zip: ____________________

In case of emergency, please contact:  ______________________________________Phone: (           )_________

Contact’s relationship to participant: _______________________________________________

CONTRACT AGREEMENT

BOOT CAMP POVERTY SIMULATION

Lighthouse Community Church

Revised 2/3/07

Check all that apply:

Poverty Simulation Weekend ($100 each person)

We, _______________________________, do hereby agree with Lighthouse Community Church to attend the BOOT CAMP Poverty Simulation and/or Service Project on the dates of ___________________________.       

We will arrive at ________________AM/PM. (Note: Poverty Simulations begin at 8 PM Friday)

We estimate our group size to be persons, which includes sponsors (average of 1 adult per 6 or 7 youth) at $100 per person for a Poverty Simulation; balance payable on arrival. We will contact the Lighthouse Community Church on the Monday prior to our arrival date to confirm final numbers. We agree to be responsible for our own group’s behavior, to select members who can adequately grow and be challenged from such an experience, bring all Release Forms for all participants, including parent signature for participants under 18, and prepare our group spiritually for the discipleship opportunity.   

If attending Poverty Simulation: We understand that Poverty Simulation is for participants who have completed 8th grade and older.  We understand that Poverty Simulation should not be used for a “mystery trip” experience and that all participants will be informed prior to signing up that Poverty Simulation is a challenging and hard weekend with the purpose of gaining understanding and Christ-based compassion for those throughout our cities, country and world who live in poverty.

IMPORTANT INFORMATION ABOUT DEPOSITS and REFUNDS:

The Deposit for Groups is $100, while the Deposit for Poverty Simulation weekends is $20 per person. For Poverty Simulations, these cancellation guidelines apply: A. If cancelling 3 months or more, full refund is available. B. If cancelling 2 months or more, deposit may be applied to a future Poverty Simulation reservation within one year. Deposits not used within one year will be considered a donation. C. If cancelling less than 2 months, deposit is forfeited and considered a donation (a worthy one!).

If you are making reservations for a combination week of Poverty Simulation followed by work week you need to pay the Poverty Simulation deposit.  For example, you will need a $800 deposit to make Pov. Sim. Reservations for a group of 40 ($20 times 40 people).  If you tell us three weeks before the event that you are only bringing 28, then you lose the deposit for those cancellations (in this example, $240).  However, if you make any cancellations more than three months prior to the event we will gladly refund you those deposits or apply them to the total cost of your group; or if you cancel more than two months prior we will apply the deposits to a future Poverty Simulation.  The point is this -- please cancel early so we have time to offer those slots to other groups who may be on our waiting list.  Thanks!

________________________(Please also print name here:  ____________________)  __________

Signature of Person in Church/Organization Authorized to Sign Contracts      Date

________________________________________________________________________

Signature of Group LeaderDateLighthouse Rep.                        Date

Leader Name (Printed):    CELL PHONE DURING TRAVEL:  ______________

Group Name: ________________________________

Mailing Address: ________________________________

City__________________State____________________Zip Code_______________

Phone: Email: ___________

Office Use only:Deposit Amount Paid: $Check #: __ Date: