Mission Forms for the Dominican Republic Trip

Dates for DR 2024 Missions Trip: 6/23/2024 – 6/30/2024

For those serving with us this year, please complete the Online Participant Agreement Form below. This form must be completed by February 1, 2024.

Mission Trip Checklist 2024 PDF

Minor Traveling Notary form* (PDF)
* Please download this PDF, print and complete for those under 18 years old.

Donation Support Letter v2

The support letter is a Microsoft Word file that you may use to request financial support from family and friends. [Note, the letter has been revised to add the EIN tax ID number.]

Dominican Republic E-Ticket

To enter and leave the Dominican Republic, you must complete the form below.

Dominican Republic E-Ticket

A few notes:

The form defaults to Spanish and you can switch it to English.
Save your Application Code to return to the form.
Take a picture of the completed form with your QR code and save it as a PDF to your mobile device.
The form allows you to enter more than one person when traveling as a family.
You should complete both entrance and exit.
Air Carrier is JetBlue
Hotel is Novus Caoba
Going to DR: Embarkation is JFK and Debarkation is STI.
Returning to USA: Embarkation is STI and Debarkation is JFK.

For those 18 years of age or older, you may use online registration forms below. Enter your name as it appears on your passport.

Online Participant Agreement Form

Name (Must match name as it appears on your passport!) *

First

Middle

Last

Phone Number *

Our primary form of communication will be via text messaging.

Date of Birth *

Current Email *

I certify I am at least 18 Years of age. *

Yes I am 18yrs. or older
No I am under 18yrs. old

Must be over 18 years of age to use online form. For those under 18yrs of age please print out form from top of page and turn in to Culture Missions or one of their leaders.

What is your Passport number and expiration date. *

Provide passport # and expiration date.

TSA PreCheck or Global Entry Number:

If you have a travel number for TSA expedited security screening, please include here.

Jet Blue Frequent Travel number.

Enter your Jet Blue frequent travel number if you have one.

Current Address *

Street address, city, state, zip (apt # if applicable)

Team Preference

Which team would you like to join? Medical, VBS, Construction, Sport Ministry. Please note that we may re-assign you do to missions needs.

PLEASE READ, Liability Release Agreement - I understand that there are inherent risks involved in any trip. Such risks may include, but are not limited to; the risk of injury, physical activity, exposure to illness, violence due to political instability, terrorism or criminal activity. Being fully informed of the inherent risks of this trip, I hereby release CULTURE CHURCH, INC., (DBA Culture Missions) as well as its pastors, staff and volunteer workers from any and all liability due to any injury, loss or damage to person or property that may occur during the course of my involvement with the Culture Missions Dominican Republic Mission Trip. * By signing I also understand and consent to the photographing or videotaping of myself during the time I am with Culture Missions for use in Culture Missions promotional materials. Transportation: I understand that Culture Missions does not own or operate the charter buses or airlines that will be used to transport the undersigned on this trip to the Dominican Republic, but that Culture Missions has hired, a third party bus charter company to provide transportation to airport and will be using a commercial airline for international travel to the Dominican Republic. I fully understand that traveling by bus and airplane involves risks and dangers of serious bodily injury, including permanent disability, paralysis, and death; these risks and dangers may be caused by my own actions or inactions, the actions and inactions of other drivers, pilots or passengers; there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and as between myself and Culture Missions, I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation on this trip. I do not waive any claims I may have against charter bus company, or commercial airline. Should I need to leave the group during this trip at any time and for any reason, due to my decisions or any other circumstances, any and all fee(s) incurred will be solely my responsibility. Medical Release: By signing this agreement, I am stating that I have personal medical and health insurance should I be injured during this trip and need medical attention. I understand I will be ultimately responsible for the cost of any medical care, even the cost of care not reimbursed by my health insurance carrier. Further, I affirm that I will have my medical card with me during the trip. Should I be in a position where I cannot verbally agree to or give medical consent, I hereby authorize person(s) listed below to give such consent. (provide authorized person(s), full name and best phone number in the box below). In the event authorized person is not available, I authorize Culture Missions to make decisions on my behalf. *

Name and phone number of person authorized to make medical decisions on your behalf.

As part of the Culture Mission’s summer mission team to Dominican Republic, I agree to participate in the training and team building meetings. I understand that these activities will provide me with the opportunity to strengthen my relationship with God as well as my fellow team members. IF A CONFLICT ARISES, PLEASE contact Pastor John Gaines. My financial commitment: I understand the cost of this year's trip is $1500.00 per person. Many airlines have a date by which we must secure our final number and it can not be changed. This is usually 60 days prior to our departure. Your place on this the team is not secure until you have deposited half of the trip cost, ($750 is required by April 1, 2024 to attend this years trip.) All trip funds must be paid by 5/1/2024. You may request a refund (request must be made in writing to our church postal address or by email) of all money paid by you (not money donated on your behalf) by 5/5/2024. If you cancel before 5/5/24, you will receive your trip funds minus $750 since the airline ticket is not refundable at that point. If a team member must cancel participation after 5/5/2024 all proceeds will go towards filling the vacancy created and will not be refunded. Finally God has provided year after year and done some pretty amazing things, so please commit the finances for this years trip to prayer. As we are believing God with bless our efforts and meet all financial goals. Health Care Each individual is responsible for healthcare coverage. NO ONE without international healthcare coverage will be allowed to participate in this years mission trip. All participants must confirm international coverage with their individual healthcare provider. As an added precaution we will be securing additional coverage which will be included with your mission trip costs to assist in fulfilling this mandate. *

Name and Date

In the event an attendee becomes sick and are unable to leave the country with the team, that individual will be responsible for cost of extra stay in country for quarantine. Culture missions can assist will travel to airport. *

Name and Date

Please list any current medical issues and food or drug allergies that may be helpful should medical attention be needed. *

Standards of Behavior: It is in the best interest of the entire group that everyone agree to the following mandated guidelines. The primary purpose of these Standards of Behavior is to ensure the safety and well-being of all Dominican Republic Mission Trip participants. I agree to: Refrain at all times from the consumption of alcoholic beverages and illicit drugs, attend all activities and meal functions, refrain from using profanity or other inappropriate language, and conduct myself in such a manner as to bring pride to myself, my family, my church, and my Faith. Waiver Release: I certify that I am of legal age and competent to sign this agreement form and that I hereby do so voluntarily. I hereby certify that I have read the participants agreement, that I agree to abide by the terms outlined in the participant’s agreement and that the information furnished on the trip application is true and correct. I understand that this document constitutes a full and complete waiver of all possible claims for any act or omission, including claims for negligence regarding injury or property damages, arising out of my participation on this trip. I understand that this Release applies to, covers, and includes unknown, unforeseen, unanticipated, and unsuspected damages, losses or liabilities, and the consequences thereof. I hereby certify with my typed name below that I have read the Liability, Transportation, Medical, Standards of Behavior and Waiver Release, and agree to all statements herein contained. *

Name and date act as electronic signature.

Comment