River Cities Community Church
Mission Trip Application
The mission of River Cities Community Church is to help people discover the lifechanging relationship of knowing and following Jesus Christ. One way we do this is by
partnering with missionaries and organizations in WV, the U.S. and around the globe.
By partnering with vocational missionaries, we not only pray for them and help them
carry out their ministries financially, but we also have the opportunity to get involved
personally by volunteering our time. Most of us have at least two weeks during the
year that we set aside for vacation. Maybe you will consider investing some of your
vacation time in eternity this year and “vacation with a purpose" by joining a church
mission trip.
We realize that not everyone is ready to go on a mission trip. It is a significant spiritual
undertaking and requires not only a consistent Christian testimony but also a mature
character.
The application is a way for our Missions leaders to prayerfully consider whether or
not someone is ready to participate in an RCCC mission trip.
Please fill out the attached form and return it to the church office.
Who can apply? Any interested Christ-follower is welcome to apply (ages for different
mission trips may vary. Please inquire about age requirements for each trip).
When will I know if I've been accepted? Once we have received your application, you
should hear something in about one week.
If you have any questions, please contact Missions Secretary, Melinda McComas
at 304.736.8197 ext. 21 or [email protected].
Application for RCCC Mission Trip
Destination: ______________________________ Dates: ______________________________
My NON-REFUNDABLE application fee of $50 is included. Check #: _________ Cash: ________
Personal Information
Name: _______________________________________________________________________
Date of Birth (MM/DD/YY): ______________________________________________________
E-mail: ______________________________________________________________________
Address: _____________________________________________________________________
City: _______________________________ State: ______________ Zip: _________________
Cell Phone: ____________________________ Home Phone: ___________________________
Is your spouse applying? [ ] YES [ ] NO
Parent or child/children applying? [ ] YES [ ] NO
Occupation: __________________________ Employer: _______________________________
Hobbies: _____________________________________________________________________
Foreign Languages spoken: ______________________________________________________
I believe that I am physically fit and able to travel by plane, train and to walk. [ ] YES [ ] NO
Travel Information
Are you a U.S. citizen? [ ] YES [ ] NO If no, citizen of: ________________________________
Passport #: _________________________ Passport expiration date: ____________________
Full name on passport: __________________________________________________________
(Please attach a photocopy of your passport or turn one in as soon as you get your passport.)
(NOTE: It takes 6 - 8 weeks to get a passport if you do not already have one!)
Insurance Company: ______________ Group: _________________ Policy #: ______________
Will your health insurance cover you while overseas? [ ] YES [ ] NO
Blood Type: __________
1. Emergency Contact: _______________________ Relationship: _______________________
Address: _______________________ City: ___________________ State: _____ Zip: ________
Home Phone: ______________ Cell Phone: ______________ Work Phone: _______________
2. Emergency Contact: _______________________ Relationship: _______________________
Address: _______________________ City: ___________________ State: _____ Zip: ________
Home Phone: ______________ Cell Phone: ______________ Work Phone: _______________
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RCCC Statement of Faith

We believe there is one true and living God who is eternal, existing in three persons, Father, Son and Holy
Spirit, each being equal, therefore deserving our worship and obedience (Deut. 6:4; Mt. 28:19; 2 Cor. 13:14).

We believe that heaven, earth, and man were created by a direct act of God (Gen. 1:1; Is. 48:13; Ps. 33:6).

We believe that Jesus Christ is the very Son of God (Heb. 1:8); that He was born of a virgin (Mt. 1:23),
and that He lived a sinless life (Heb. 4:15), that He was crucified (1 Pet. 2:24), died as a penalty for our sins
(1 Pet. 3:18), and was raised from the dead bodily on the third day (1 Cor. 15:4). He is now ascended to the
Father's right hand (Heb. 12:2) where He is the head of the Church (Col. 1:18) and intercedes for believers
(Heb. 7:25).

We believe that God the Holy Spirit is a person and possesses all the divine attributes (Acts 5:3-4). He
indwells all believers (1 Cor. 6:19), placing them in the Body of Christ (1 Cor. 12:13) and sealing them at the
moment of salvation (Eph. 1:13). He now fills (Eph. 5:18), guides (John 16:13), teaches (John 14:26), and
empowers (Acts 1:8) the believer to the glory of God.

We believe that all of the Bible is the inspired Word of God. By "inspiration" we mean that the Bible was
given as men were "moved by the Holy Spirit." We believe that the Bible is the divinely authoritative
standard by which men should live (2 Tim. 3:16; 2 Pet. 1:20-21).

We teach that by His sovereign choice and love, God sent His Son into the world to save sinners (Eph. 1:4-5;
2 Thes. 2:13-14).

We believe that the Lord Jesus Christ made a perfect atonement for sin through His death by the shedding of
His blood; therefore, men are saved and justified on the basis of His work on the cross alone. This salvation,
which provides forgiveness of sins, the impartation of a new nature and eternal life, is by grace alone and
entirely apart from good works, baptism, church membership or any efforts by man (Rom. 3:22-24; Eph. 2:89; Titus 3:5-7).

We believe that a true believer cannot lose his salvation because God has made him eternally secure
(1 Pet. 1:3-5; John 10:27-29; Rom. 8:1). However, sin may interrupt the joy of his fellowship with God and
result in the loving discipline of his heavenly Father (Ps. 51:12; Heb. 12:5-6).

We believe that children of God are joint heirs with Christ (Rom. 8:17); therefore, at death their spirit
enters into the blessed presence of Christ (2 Cor. 5:6-8) and at the rapture their bodies will be raised to the
likeness of Christ (1 Thes. 4:13-17). In contrast, the lost will enter conscious eternal punishment at death
(Rev. 20:11-15).

We believe that every Christian should be growing in spiritual maturity through obedience to the Word
of God (1 Pet. 2:2; 2 Tim. 3:16-17) and the indwelling Spirit (Gal. 5:16-18, 22-25).

We believe the Church is the Body of Christ (Eph. 1:22-23). It is made up of local assemblies of believers
for the purpose of edification and evangelism (Mt. 28:19-20), to administer the Church ordinances of
baptism (Mt. 28:19-20), and communion (1 Cor. 11:23-26), and to give opportunity to express the spiritual
gifts (Rom. 12:4-8).

We believe God created man and woman in His image (Gen. 1:27) to be sexually different and mutually
complementary. They become one flesh in marriage (Gen. 2:24; Mark 10:6-8), and are to experience sexual
fulfillment only in the context of marriage (Heb. 13:4). Deviations from God's plan including sex before
marriage, adultery, homosexuality, etc. (see Lev. 18) are strictly forbidden and condemned by God (1 Cor.
6:9; Rom. 1:24-32). Accordingly, people who practice these sins will not be permitted into membership of the
church, employed by the church, allowed use of the facilities of the church, or be joined in holy matrimony or
civil unions in the church. We recognize that God loves all men (John 3:16) and offers forgiveness to all who
receive Christ. (1 Cor. 6:9-11).
Do you agree with the Statement of Faith above? [ ] YES [ ]NO
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Background Information
Describe how you came to know Christ as Savior & how He is presently working in your life
(use the back of this page).
Explain your understanding of the Gospel (use the back of this page).
Are you a member of RCCC? [ ] YES [ ] NO If no, are you a member of another church?
[ ] YES [ ] NO If yes, of which church? ______________________________________________
Please list any ministries or classes/small group Bible studies you’ve been involved in during
the last two years (at RCCC or elsewhere): __________________________________________
_____________________________________________________________________________
Have you ever participated in any RCCC (or other) mission trips?
Trip: ____________________ Year: _______ Leader name/phone #: _________________
Trip: ____________________ Year: _______ Leader name/phone #: _________________
Trip: ____________________ Year: _______ Leader name/phone #: _________________
Please describe your reasons for wanting to participate in this mission trip:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Preferred areas of service: Children ___
Crafts ___
Teaching ___ Music ___
Teens ___
Games ___
College ___
Video ___
Adults ___
Photography ___
What kinds of experience do you have for any of the areas you checked?
_____________________________________________________________________________
_____________________________________________________________________________
Do you have other abilities that might help with this trip? (i.e. computer, medical)
_____________________________________________________________________________
What are a few of your strengths or gifts? __________________________________________
_____________________________________________________________________________
What are a few of your weaknesses? ______________________________________________
_____________________________________________________________________________
What are the most significant events in your life in the past two years? (may use back of page)
_____________________________________________________________________________
_____________________________________________________________________________
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References (RCCC pastors, staff, elders, deacons, small group leaders, etc.)
Name: __________________________ Phone # or email: _____________________________
Relationship: _____________________ How long have you known this person? ___________
Name: __________________________ Phone # or email: _____________________________
Relationship: _____________________ How long have you known this person? ___________
Health Information
Do you have or have you ever had:
[ ] Fainting Spells
[ ] Heart Problems
[ ] Eating Disorder
[ ] Hearing Difficulties
[ ] Mental Difficulties [ ] Digestion Problems
[ ] Breathing Problems [ ] Back or Neck Problems
[ ] Diabetes
[ ] Seizures
[ ] Asthma
[ ] Allergies
[ ] Nervous Breakdown
[ ] High/Low Blood Pressure
[ ] Blood Clots [ ]Others _______________
If yes, please explain: ___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Do you have any chronic illness or allergies? [ ] YES [ ] NO
If yes, how are you managing/treating these? _______________________________________
List any medications (both prescription and non-prescription) you take & how often: ________
_____________________________________________________________________________
_____________________________________________________________________________
How would you describe your overall health and fitness?
[ ] Excellent
[ ] Good
[ ] Average
[ ] Needs Work
[ ] Poor
Do you have any condition which might affect your ability to fully function as a missionary on
this trip (i.e., fear of flying, depression, anxiety, sleeping disorder)? ______________________
_____________________________________________________________________________
Are you aware of any physical limitations (or other issues) that could affect your ability to
travel, to do mission work, or otherwise work with people? ____________________________
_____________________________________________________________________________
Please ask your primary care physician to complete the following:
Based on my knowledge of this applicant’s medical history and answers above, I recommend
that he/she be considered physically/mentally fit for this mission trip. [ ] YES [ ] NO
___________________________________
Physician’s Signature
___________________________________
Print Name
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Other Information
Participation in a RCCC mission trip is not for everyone. It puts you on the “front-lines” of
spiritual battle. It carries with it a responsibility to represent RCCC and the Lord Jesus Christ.
All participants must be persons of integrity and sound biblical convictions.
Are you aware of any area of your life that might not be considered above reproach?
[ ] YES [ ] NO (Please answer honestly. A “yes” answer does not necessarily disqualify you from the mission, but will probably mean that a pastor or missions leaders will discuss it further with you.)
Have you ever been convicted of or pleaded guilty to a crime? [ ] YES [ ] NO
If yes, please explain:___________________________________________________________
_____________________________________________________________________________
We must ask the following since many of our short term missions projects involve close
contact with and/or ministry to youth.
If you were a victim of abuse while a minor, have you sought professional help as you work
to resolve the issues surrounding this? [ ] YES [ ] NO [ ] NOT APPLICABLE ………...………………...
(If you prefer, you may refuse to answer this question, or you may discuss your answer in confidence
with any of our pastors or with Beth Calvert, our Life Skills Director. Answering yes, or leaving the
question unanswered, will not automatically disqualify any applicant from the mission.)
By signing below, I agree, that if accepted, I will:
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Authorize a background check.
Abide by the requirements and objectives of RCCC’s missions ministry.
Attend all orientation, training, prayer and fellowship meetings, fundraising activities, and carry out
assignments given me by the team leader(s).
Be willing to adapt to other cultures and not exhibit any form of prejudice or superiority.
Remember that I am going as a guest, working at the invitation of the local pastor or missionary
and will respect the host’s ministry goals and methods.
Abide by the regulations and restrictions set by the host missionaries regarding dress, speech, the
expression of political opinions, and public behavior in order to enhance overall effectiveness of
the team and fulfill the missionaries’ strategic ministry objectives.
Live an above reproach lifestyle and avoid causing my weaker brother to stumble.
Understand that the team leaders have the authority to dismiss me from the mission at any time,
and while on the field, to send me home at my own expense, for behavior or conduct, including but
not limited to the following: inappropriate interaction with members of the opposite sex and or/
with in-country hosts or other nationals; immoral behavior; use of illegal drugs; abuse of legal
drugs; use of alcohol or nicotine; involvement in gambling or pornography; refusal to cooperate
with those in authority; divisiveness; violation of local or U.S. laws and other similar conduct.
Signature: __________________________________________ Date: _____________________
Once you’ve completed your application, please bring it to the church office or mail it to:
River Cities Community Church
4385 Route 60 East
Huntington, WV 25705
Attention: Missions
The Missions Secretary or Mission Trip Team Leader will inform you as soon as possible about
team membership. Thank you for your interest!
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Waiver and Release of Liability
Assumption of Risk
I understand that my volunteer work for River Cities Community Church requires travel and
volunteer activity throughout the world that may include undeveloped, politically unstable and
dangerous areas which entails a risk of sickness, bodily injury, or death. I expressly agree to assume
the risks inherent in the travel and volunteer activity, in conjunction with and on behalf of River
Cities Community Church.
Full and Complete Release
I understand and acknowledge that this Waiver and Release of Liability is intended as a complete
and continuous release for all trips or transportation provided to me or volunteer activity in
which I engage for River Cities Community Church. No other documents, oral promises or other
information can be used to modify or alter the terms of this Release. This Release is fully integrated,
final and complete statement of the Release I have enter into. If any provision of this Release is
declared invalid, the remaining portions remain enforceable.
Indemnification Obligation
I agree to hold harmless and indemnify River Cities Community Church and the parties being release
for any costs or attorneys’ fees that may be incurred as a result of any challenge to this Release or
legal action brought in contravention to this Release in litigation resulting from injury, death or
property damage, in connection with my volunteer activity with River Cities Community Church.
Right to Legal Counsel
I understand and acknowledge that I may seek advise from legal counsel before signing this Release.
By signing this Release, I acknowledge have either sought the advice of legal counsel or wish to now
intentionally waive the opportunity to talk to a lawyer by my signature of this Release.
Understanding of This Document
I understand and acknowledge that by signing this Release, I am confirming that I knowingly
understand the language used in int. I represent that if there is any word or phrase that I did
not understand, that I have sought the advice of an attorney or other person for explanation.
I acknowledge that I voluntarily signed this Release without any coercion by River Cities Community
Church, its agents, representatives, or assigns.
Physically Fit
I hereby warrant and represent that I am physically fit and capable of taking part in the River Cities
Community Church activity. I understand that, as a volunteer, I am not covered under any River
Cities Community Church insurance, workers compensation or otherwise.
Medical Treatment
I hereby authorized River Cities Community Church, their representatives or assigns, or any such
volunteer activity authority to request and authorize any x-ray examination, anesthetic, medical
or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be
rendered under the general or specific supervision of, any licensed physician or surgeon, whether
such diagnosis or treatment is rendered at the office of said physician or at a hospital for my benefit
Release 1
in the event of any injury or sickness sustained by me while on such activity including, without
limitation, while traveling to and from, or engaging in volunteer work in any foreign country. I agree
to pay for all such treatment and to reimburse River Cities Community Church for all costs and expenses incurred by it with respect to such treatment.
Governing Law
I understand and acknowledge that this Waiver and Release of Liability is a contract governed by
West Virginia law for which West Virginia is the proper venue.
I, THE UNDERSIGNED HAVE READ THE FOREGOING AND, HAVING BEEN ADVISED BY COUNSEL, IF
ANY, FULLY UNDERSTAND AND AGREE TO ITS TERMS. I UNDERSTAND THAT I AM VOLUNTARILY
SIGNING THIS RELEASE.
________________________________
Signature
_________________________________
Date
________________________________
Print Name
If you are under the age of 18, your parent(s)/legal guardian(s) must also agree to the following:
I/we certify that I/we am/are the responsible parent(s) or legal guardian(s) of the above applicant,
that I/we have read the foregoing Release Form and fully understand, and agree to its terms, and
grant my/our permission for my minor child/ward to participate in this mission project/trip.
Both persons must sign if both are responsible parents or legal guardians of the minor.
________________________________
Signature of Parent or Legal Guardian
If Volunteer is Under 18 Years Old
_________________________________
Signature of Parent or Legal Guardian...
If Volunteer is Under 18 Years Old
________________________________
Print Name of Parent or Legal Guardian
_________________________________
Print Name of Parent or Legal Guardian
Release 2