Document Packet

This packet contains the individual member forms needed to send a team from the California-Nevada Annual Conference.  Not all forms are required for each mission type; see the list below for each type’s requirements. For Insurance information and forms, please scroll down to checklists.
 

In-State/In-Conference Mission

  1. Medical and Emergency Information Form with an attached copy of team member’s Medical Insurance Card+
  2. Domestic Accident & Medical Travel Insurance (Excel spreadsheet)
  3. Liability and Photo Release
  4. Mission Covenant Form and Safe Sanctuaries Agreement
  5. Parental Consent Form* (members under 18)

Out-of-State/National Mission

  1. Medical and Emergency Information Form with an attached copy of team member’s Medical Insurance Card and Driver’s License
  2. Domestic Accident & Medical Travel Insurance (Excel spreadsheet)
  3. Liability and Photo Release
  4. Mission Covenant Form and Safe Sanctuaries Agreement
  5. Parental Consent Form* (members under 18)

International Mission

  1. Medical and Emergency Information Form with an attached copy of team member’s Medical Insurance Card and Passport
  2. International Accident & Medical Travel Insurance (Excel spreadsheet)
  3. Liability and Photo Release
  4. Mission Covenant Form and Safe Sanctuaries Agreement
  5. Notification of Death
  6. Parental Consent Form* (members under 18)

Optional Forms – to be used at Team Leader’s discretion and depending on mission site

  1. Team Member Application
  2. Healthcare Professional’s Information and Team Member Certification
     

*For out of state and/or out of country trips, the Parental Consent form must be signed and notarized by both parents or legal guardians for each minor on the team, even if one or both parents (guardians) are part of the team.  If one parent is deceased, attach a copy of the death certificate; if one parent has sole legal custody due to divorce, attach a copy of the divorce decree.   For in state trips, a signature by one parent or guardian is sufficient.  State and country are defined by the youth’s primary residence.

+ In-Conference mission participants without medical insurance should purchase accident insurance as for National missions.  See below under #6 Insurance.
 

Form Distribution/Disposition:

  • The Team Leader carries the signed originals of the Medical Information and Consent, and as appropriate, Notification of Death and Parental Consent, forms on the mission trip itself. It is recommended that the medical forms be placed in a sealed envelope to be is opened only in an emergency. Any youth travel consent forms should be packaged separately from the medical forms as they may need to be more readily available.The Team Leader should ensure that several trusted adults know the location of these forms in event of an emergency. At the completion of the mission, all originals are to be shredded.

  • Electronic or paper copies of the Medical and Emergency Information Form, and as appropriate, Notification of Death and Parental Consent, forms must be sent to the Annual Conference UMVIM Coordinator or other readily contactable person (e.g. team’s pastor at home) for backup use during the team’s mission trip.This copy of the forms, electronic or paper, is to be shredded or deleted on the team’s return.


Steve Elliott
Conference Disaster Response & UMVIM Coordinator (Director)
(925) 640-9797

Shari Sandoval
Senior Administrative Assistant
(916) 374-1528