Date

Application Date

YYYY

Preferred Name

First and Last name - (Preferred name)

Mission Trip Selection

Additional Mission Trip(s)

Email Address

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(best contact)

Country

(###)

###

####

Date of Birth

YYYY

Passport Name

EXACTLY as it appears on your passport

Passport Number

if you don’t have a passport or need to update your passport, please begin the application process as soon as your application is accepted. Please ensure that your name on this application is exactly as on your passport or passport application

Passport Expiration Date

(*if your current expiration date is less than 6 months after the return date of the mission, please renew your passport)

YYYY

Flights - confirmation of AFM booking

If you purchase your own flight you are also responsible for your own trip insurance and medical evacuation coverage

Preferred Airport

AFM tries to fly you out from your preferred airport. However at times flight schedules to Africa may require a second or third choice for flights.

Frequent Flyer Information

providing your frequent flyer information allows AFM to connect your flight to your frequent flyer account (if that is the airline you are flying on).

TSA Pre-check/Global Entry

Golf Shirt Size

You will be provided 2 AFM Golf Shirts for training days on the mission trip

PPE: Will you need help acquiring firefighter PPE

We ask team members to bring a set of firefighter PPE to utilize during the training and to donate after training. PPE should be less than 15 years past date of manufacture.

If you answered Yes or Unsure to the above question please list your sizes for PPE

List your sizes for bunker coat, pants, boots and gloves

Room Preference

Add Safari

Kenya: 3 day 2 night Safari to Maasai Mara or Amboseli National Park (includes transportation, lodging, food & park fees). *additional cost, (see team information page) due with final payment Malawi: 3 day 2 night at Mvuu Lodge Liwonde National Park (includes transportation, lodging, food & park fees) *additional estimated cost, (see team information page) due with final payment Zambia - Safari option is not available for Zambia; if you want to plan a safari in Zambia, you will need to make your own arrangements and book your own flights. (select NO if you are traveling to Zambia)

Have you received the COVID-19 Vaccine?

Due to frequently changing requirements related to COVID-19, AFM is collecting this information for all team members.

Describe any medical conditions, allergies or dietary rescrictions that could affect your participation in this trip

please note, you are responsible for managing your personal medical conditions, allergies and dietary restrictions during the trip.

Emergency Contact Name

Relationship to Emergency Contact

Emergency Contact Email

Emergency Contact Phone

Country

(###)

###

####

Insurance Beneficiary Name

*AFM carries death and dismemberment coverage for all of our volunteers. If we are booking your travel, we will also obtain medical evacuation coverage & trip insurance on your behalf. If you are booking your own travel YOU will be responsible for obtaining medical evacuation coverage & trip insurance.

Insurance Beneficiary -relationship to applicant

We will be contacting 3 references. Please list three references other than relatives that we may contact:

1 Reference name/relationship

1 Reference Email

1 Reference Phone

Country

(###)

###

####

2 Reference name/relationship to you

2 Reference Email

2 Reference Phone

Country

(###)

###

####

3 Reference name/relationship to you

3 Reference Email

3 Reference Phone

Country

(###)

###

####

Employment: List current job, responsibilities and supervisor

Have you ever been convicted of a felony?

Africa Fire Mission works with vulnerable populations. A felony record will not automatically exclude you from participation, however, we will have a specific conversation with you about the conviction, any restrictions, and may request additional background checks and references. Visa’s to certain countries can also be denied for some convictions on a country by country basis.

Additional Information

Brief Bio

Please provide a brief bio that can be used to help introduce you to our partners.

Personal Awareness: Describe yourself (introvert/extrovert; feeler/thinker; decisive/indecisive; outgoing/quiet):

How do others often describe you?

What do you see as your strongest assets to Africa Fire Mission?

Mission Experience: Describe any past involvement with cross-cultural training or ministry:

Describe past mission or humanitarian trip experiences (when, where, what you did)

What drew your interest in participating in a team trip with Africa Fire Mission?

What is the response of your family/friends about your participating in this trip?

Agreements: Please check all of the following boxes to indicate your understanding & agreement.

I understand that my $300 deposit is due with the application and is non transferable/non-refundable. (You may pay by check [checks payable to Africa Fire Mission, PO Box 53242 Cincinnati, OH 45253], electronic deposit or credit card [below]) .

I understand that all contributions to Africa Fire Mission, including this deposit, are given freely. Africa Fire Mission has complete discretion and control of all contributions and is committed to providing reasonable measures to ensure that donor-preference gifts are used for their intended purposes and projects.

I am committed to participate in the training, preparation sessions and fundraising for this trip. I am responsible for attending all training either live or through recorded sessions. Failure to participate in all training may result in removal from the team.

I understand I must have funds submitted to cover half of the cost of the trip 4 months before travel and the balance of the funds at least 3 weeks before departure. (Africa Fire Mission will provide a schedule of payment due dates) Failure to submit payment as scheduled may result in removal from the team.

I understand that once donations/payments are received by AFM, the donations are not refundable. Cancelling after payments have been received will result in AFM using the funds as it's discretion. AFM does obtain trip insurance when flights are purchased that may allow you to recover your airfare and some other costs in the case of an emergency.

I understand that I am responsible for communicating to potential donors that if something should happen that does not allow me to travel with the team, donations will be used for other AFM goals and projects.

I will submit a RESUME and COLOR COPY of PASSPORT to teams@africafiremission.org following submission of this application

Photo Release

I hereby give AFRICA FIRE MISSION and their legal representatives and assigns, the right and permission to publish, without charge, photographs/video taken during a AFRICA FIRE MISSION sponsored event. These photographs/video may be used in publications, including electronic publications, or in audiovisual presentations, promotional literature, advertising, or in other similar ways. I am 18 years of age or older and am competent to contract in my own name (if under 18, I understand that my parent or guardian must sign an additional waiver). I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. Do you agree with the above Photo Release?

Personal conduct, communication & fundraising policies

Africa Fire Mission expects professional conduct on this mission. You are representing Africa Fire Mission, our partner organizations and the Fire Service at all times on this trip. All trip participants are required to follow the trip schedule and participate in all group functions. • Permission to deviate from scheduled activities must be obtained from the trip leader. • Be flexible, changes in the schedule will occur and information may not be available until the last minute. • Separation from the group is not allowed without prior approval by the team leader. • Always let the team leader know your whereabouts. NEVER wander off or go exploring by yourself. Africa Fire Mission staff and trip leader are the recognized authorities on the trip. Any insubordination toward AFM staff, trip leader or AFM partners may result in immediate termination of your mission trip and you will be sent home at your expense.  Trip participants are expected to respect the culture and traditions of our hosts. Be willing to give and take and maintain the spirit of unity. Extend politeness and courtesy to those with whom we come in contact (missionaries, nationals, team leaders, team members). You will be expected to acclimate to the host culture. This may mean eating food you are unfamiliar with or participating in foreign customs. Embrace the opportunities to learn about a new culture - complaining about or comparing the differences from U.S. culture is not beneficial to the experience.   It is important that your dress in a neat, clean, modest and appropriate for the activities of the day. Your appearance is important for our reputation and your safety. Follow your team leaders guide regarding any uniform, personal protective equipment and the team dress code expectations. Giving gifts of any kind to nationals without consulting AFM staff or team leader is not permitted. The preferred method of giving is through structured programs by AFM and our partners. The exchange of personal information with nationals is not permitted without team leader approval. This can create an expectation of ongoing support that may be detrimental to AFM’s ongoing mission. Team members are expected to be transparent with financial matters and support raising. -Funds given toward this mission will be used for the costs of this trip or other AFM activities -If you are unable to go or funds are received by AFM in access of the trip costs, all funds will be used at the discretion of Africa Fire Mission. -Payments for the trip need to be made on time. Failure to do so may result in not being able to participate in the trip. -I agree to follow all fundraising policies provided by Africa Fire Mission. I have read the above expectations and I agree to abide by them at all times.  

CONSENT AND LIABILITY RELEASE AND INDEMNIFICATION

You have chosen to participate in a mission trip with Africa Fire Mission and you could be subject to personal injury. To participate in this activity, sign this form to release and indemnify Africa Fire Mission and all leaders and other organizations involved in this mission trip from liability.   In consideration of being permitted to participate in this mission trip and intending to be legally bound, I, for myself, my legal guardian, my personal representatives, heirs, and next of kin:   1. Hereby release, waive, discharge, and covenant not to sue AFRICA FIRE MISSION, all leaders, and organizations associated with AFRICA FIRE MISSION in this mission trip from any and all claims and/or legal liability that I, my legal guardian, my personal representatives, heirs, and next of kin may have against AFRICA FIRE MISSION in this mission trip, for any and all losses or damages and any claim or demands thereof on account of injury to my person or property, including my death, arising out of the mission trip, including any negligence of AFRICA FIRE MISSION and any leaders and organizations involved. Further, I hereby release waive, discharge, and covenant not to sue AFRICA FIRE MISSION and individuals or other organizations associated with AFRICA FIRE MISSION in the mission trip for any claims, including, BUT NOT LIMITED TO, sickness, injury, or death that may result from hazardous traffic, poorly constructed roads, dangers resulting from military or political problems, sickness or disease.   2. Hereby agree to indemnify and to hold harmless AFRICA FIRE MISSION and any of the individuals and other organizations associated with AFRICA FIRE MISSION in this mission trip from any claims or liability arising out of my participation in this mission trip as additional consideration.   3. Hereby authorize AFRICA FIRE MISSION and its leaders to make essential decisions on my behalf regarding medical treatment, emergency surgery, or hospitalization should such medical treatment be necessary and should all reasonable and practicable efforts fail in first contacting members of my family and responsible leaders on my visiting mission team.    4. Hereby agree to NOT hold AFRICA FIRE MISSION, any individuals or other organizations associated with AFRICA FIRE MISSION in this mission trip responsible or liable for the payment or any medical bills incurred as a result of this mission trip.   5. Hereby agree that in the event that I die while on this mission trip that I, my estate, my legal guardian, my personal representatives, heirs, and next of kin, will assume complete responsibility for the total cost of shipping my body.   6. Hereby agree to read and abide by the rules, regulations, and guidelines set forth by AFRICA FIRE MISSION and to abide by all decisions made by leaders and those in authority.   7. Hereby agree that in the event that I do make a claim, I, my legal guardian, my personal representatives, heirs, and next of kin, shall pay all legal fees and costs incurred by AFRICA FIRE MISSION and all individuals and organizations associated with AFRICA FIRE MISSION in the mission trip to defend against such claims.   8. Hereby assume full responsibility for any risk of bodily injury, death, or property damage arising out of or related to the mission trip, including any acts of negligence or otherwise.   I HAVE READ THIS CONSENT AND LIABILITY RELEASE AND INDEMINIFICATION AGREEMENT, FULLY UNDERSTOOD ITS TERMS, UNDERSTAND THAT I MAY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARLY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Do you agree with the above Consent and Liability Release and Indemnification?

I agree that this application is complete and accurate. By submitting this I am electronically signing the agreements within the application.

Thank you for your application. We will review your application and be in touch with you regarding your participation in the mission. -Africa Fire Mission.

Mission Trip Application

Africa Fire Mission

Mailing: P.O. Box 53242, Cincinnati, OH 45253

Office/Shipping Address: 2859 Boudinot Ave, Suite 330, Cincinnati, OH 45238

513.620.4236 | INFO@AFRICAFIREMISSION.ORG

PRIVACY POLICY