GSM Fort Wayne Mission Trip

GSM Fort Wayne Mission Trip Thank you for your interest in the Fort Wayne Mission Trip with Grace Student Ministries. The trip is July 20-26, 2025. Total cost is $250. Registration closes April 1st. This trip involves light duty construction, painting, home clean-up, and potentially VBS elements. Sleeping arrangements are floor sleeping in a partner church. Showers and good food will be available daily. This is a great chance to grow through serving and personal discipleship. Your registration must be paid in full before May 1st. Students entering 7th MAY register as well as those who have completed grades 7-12.

Tip: When Registering, please enter the name of the person actually attending this event (not the person signing them up, if different) in the first 2 boxes. Thanks!

* Student First Name

* Student Last Name

* Student Birth Date

* Student Grade in School

* Student T-Shirt Size

* Parent/Legal Guardian Name

* Student Address

* Student Home Phone

* Student Mobile Phone

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* Student Email

* Student Emergency Contact

* Student Emergency Contact Phone number

* Medical Information: Is your student presently being treated for an injury or sickness or taking any medication? If yes, please explain.

* Health History: Does your student have, or has your student ever had, any of the following: Allergies, Asthma, Diabetes, Hay Fever, Heart Murmur, Kidney Disease, Seizure Disorders? If yes, please explain:

* Sleep Issues: Does your student ever sleepwalk or experience night terrors?

* Blood Type: Please enter student's blood type (If known):

* Limiting Factors: Does your student have a physical handicap or illness that would prevent him or her from participating in normal rigorous activity? If yes, please explain:

* Doctor's Information: Please provide the name of your Family Doctor and a telephone number for their practice:

* Insurance Information: Please provide the name of your health insurance company and policy number:

* Medical Treatment Authorization: In the event that I cannot be reached, I authorize the Student Ministries Pastor or another Adult Leader designated by them to call a doctor and to provide necessary medical services if my student is injured or ill. I understand that I, the parent or legal guardian will be responsible for medical expenses incurred. Please type your name below to give authorization:

* I, the undersigned, being the parent or legal guardian of the student above, give permission to Nate Patterson, Student Ministries Pastor, and GSM Leaders/Volunteers to transport my student to, from, and around Fort Wayne, Indiana for the GSM Fort Wayne Mission Trip. Please type your name in the box below to give consent.

* I, the undersigned, being the parent or legal guardian of the student named above, do hereby consent to the participation of my student in Grace Church Student Ministries Middle School Camp. Further, I certify that my student is physically fit and adequately prepared to participate in all recreational activities and sporting events. Please type your name below to give consent:

* I, the undersigned, being the parent or legal guardian of the student named above, do hereby consent to the participation of my student in Grace Church Student Ministries Fort Wayne Mission Trip. Further, I certify that my student is physically fit and adequately prepared to participate in all physical labor and recreational activities. Please type your name below to give consent:

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