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Medical ApplicationDana.snyder2018-01-18T21:06:02-06:00

Medical Mission Team Member Application

The completion of the form below will enable Healing Nations to consider you for short-term medical ministry in a Christian mission setting. All information entered is confidential and will only be shared with appropriate personnel. Before beginning, you will need the names and e-mail addresses of two references, and be prepared to upload a color copy of your passport picture page (any app such as CamScanner can capture the image on your phone and email it to you. Once you save the picture to your computer, you are ready to upload). If you do not have a passport, or need to renew it, visit https://travel.state.gov/content/travel/en/passports/apply-renew-passport.html. Fill out the appropriate form, make a copy and scan to upload during this trip application process.

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  • General Information

    You will receive an e-mail from Healing Nations and Clear Investigative Advantage (CIA) requesting permission for a mandatory background check.
  • Emergency Contact and Medical Information

    As standard procedure, we require the following information from everyone participating on a trip with Healing Nations. This information will be kept confidential.
  • (Be sure to bring your allergy and/or prescription medications in their original containers)
  • References

    Please list two references and let them know they will be receiving an e-mail from Healing Nations with a link to our reference forms. Your application is not considered complete until your references have completed their forms.
  • Please upload a color copy of pages 2/3 of your passport. If you have not yet received your passport, please upload a copy of your passport application. If you haven't yet applied for a passport, send your passport application to [email protected] as soon as you've submitted it.
    Drop files here or
    Accepted file types: jpg, png, pdf, Max. file size: 250 MB, Max. files: 2.
    • MM slash DD slash YYYY
    • Project Waiver, Crisis Policy, and Code of Conduct

    • Project Waiver of Right and Release:
      As a relief organization that completes overseas projects, and given that dangers abound in the world we live in, Healing Nations (HN) realizes that there are inevitable risks to staff and volunteers.These risks include serious physical injury, disease and even death. Some of our projects are based in countries with political situations that can become unstable or hostile to Westerners or Christians very rapidly, possibly resulting in temporary detention, even when no law has been broken. The potential forinjury may be aggravated in some countries by primitive living conditions or health facilities. Moreover, the technology and wealth needed for modern means of transportation and communication may not be available at certain project locations, as most projects are located in developing nations. HN prayerfully seeks wisdom and knowledge in providing guidance for volunteers involved in HN projects. Policies and procedures are specifically planned to reasonably anticipate need for protection of the health and safety of the staff and volunteers participating in projects. The leadership staff associated with each project has been carefully chosen and will exercise the wisdom and knowledge God has given them. Nevertheless, all matters are in the hands of the Lord and HN cannot anticipate or plan for all risks.

      This is a legal document. by signing that you understand and agree with this document below, you are giving up certain legal rights including the right to sue. You are also assuming certain obligations. despite precautions taken, accidents and unfortunate circumstances occur and therefore this agreement must be signed.

      By signing below, you agree that:
      - I understand there are inevitable risks involving, among other things, natural disasters, changes in political situation, different and primitive living, working and healthcare facilities, uncertain transportation and communication facilities, and possible acts of terrorism or war.
      - I accept full responsibility for all risks of injury to my person or property, and even death in any way related to, traveling to or from or participating in the trip. I hereby release and forever discharge Healing Nations and their affiliates, members, directors, officers, leaders, agents, volunteers and/or employees from any and all actions, causes of actions, suits, claims, demands, liabilities and expenses that I now have or may have in the future in connection with, arising from or related to, my travel to or from the location of the trip or my involvement in or participation in the trip, whether caused by the negligence or wrongful act of any person;
      - I am fully aware that there are serious risks associated with traveling to developing countries and I have considered the medical recommendations given to me by Healing Nations in connection with the travel related to this trip, including, but not limited to, precautions when traveling to an area associated with Zika Virus. I agree that if I do not fully and completely comply with the medical recommendations, I shall accept full responsibility for the resulting consequences and hereby release and forever discharge Healing Nations, its affiliates, members, directors, officers, leaders, agents, volunteers and/or employees from all actions, causes of actions, suits, claims and demands whatsoever that may arise as a result of my failure to fully and completely comply with the medical recommendations;

      Crisis Management
      It is the policy of Healing Nations that in the event any of its members, their families, or its facilities are threatened by a significant crisis, a Crisis Management Team will be formed to handle the crisis through resolution and follow-up.
      - Ransom and Extortion: It is the policy of Healing Nations that ransom or other extortion should not be paid. If at all possible, alternative resolutions that do not involve payment of ransom or extortion should be sought during negotiations. The final decision on the payment of ransom or extortion, or the concession to other demands issued through hostage taking or extortion shall be made by the Crisis Management Team.
      - Evacuation: It is the policy of Healing Nations that the decisions to evacuate a particular area shall be made by the Crisis Management Team. If the emergency is sudden and normal communication to the Crisis Management Team are not possible, the Healing Nations team leader may make the decision to evacuate if he/she feels that it would be unsafe to remain.
      - Post-crisis Counseling: It is the policy of Healing Nations that those personnel who have been directly involved in a crisis receive an opportunity to debrief with the Healing Nations team leader, and/or Crisis Management Team. If necessary, HN will provide the means to an evaluation from a qualified mental health professional. Any further professional treatment recommended may be pursued at the cost of the individual seeking counseling.
      -
      By signing below, I agree that:
      - I have read the Crisis Policies of Healing Nations and agree to be bound by its terms. I acknowledge that if I, or any other person(s), am kidnapped or used for extortion purposes, it is the policy of Healing Nations not to pay a ransom or comply with any demands made by the person(s) perpetrating the kidnapping or extortion. I hereby release and forever discharge Healing Nations, its affiliates, members, directors, officers, leaders, agents, volunteers and/or employees from all actions, causes of actions, suits, claims and demands whatsoever that may arise or result from my or any other persons’ kidnapping or use for extortion purposes;
      - In case of any accident or illness, I give permission to any staff member, associate staff member or other volunteer of Healing Nations, or its affiliates, or authorized representative thereof, to seek any medical attention or treatment deemed necessary for me by the individual. I hereby release and forever discharge Healing Nations and their affiliates, members, directors, officers, leaders, agents, volunteers and/or employees from all actions, causes of actions, suits, claims and demands whatsoever that may result from or in connection with such accident or injury from or in connection with medical treatment administered in connection with said accident or injury. I will further indemnify and save them harmless from any and all costs, liabilities, expenses, claims, causes of action, suits or demands incurred by them, made, or taken against them as a result of, connected with or relating to such accident or illness and the medical treatment administered in connection therewith;
      - I agree to indemnify and save harmless Healing Nations and their affiliates, their staff members, associate staff members, and volunteers from all claims, demands, suits or actions (including costs of defending them) against any of them by me or by any person injured or who suffered damage to person or property as a result of my action or in any way arising out of my participation in or any aspect of this trip, including the cost of defending any such suits, actions, or claims;
      - I will conduct myself in a manner appropriate to a volunteer participant in the trip and abide by all rules, regulations, orders and directives given to me by Healing Nations and their affiliates and agents in connection with any matter relating to the trip.

      Code of Conduct:
      Healing Nations exists to inspire spiritual vibrancy through worldwide compassion. Our international host partners may have a different worldview and cultural context than what we have in the developed Western world. It is possible that my views may differ than that of our host partners. Out of love, respect and care for our hosts and the people we are serving, I agree to the following Biblical standards of behavior and customs while participating in a Healing Nations facilitated trip:
      - I commit myself to love and serve others. This includes respect for all people regardless of race, gender, social status or stage of life.
      - I commit myself to refrain from criminal violence (2) , drunkenness (3), profane language (4) , involvement in the occult (5) , premarital sex (6) , living common law (7) , adultery (8) , homosexual behavior (9) and dishonest practices such as cheating (10) and stealing (11) .
      - I commit myself to maintain the highest ethical standards and honesty (12). I will make lifestyle choices with a high level of consideration for those around me (13) . I will maintain discreet inoffensive behavior in relationship to the opposite sex (14) , and will abstain from the use of illegal drugs, marijuana, tobacco, and alcohol (15) .
      - I commit myself to be respectful of the beliefs of a field partner, even if their teachings go against my personal, cultural or spiritual beliefs.
      - I am in agreement with this Code of Conduct and agree to submit to these disciplines for the duration of the trip.

      1 john 13:34,35; 1 corinthians 13; philippians 2:1-8
      2 romans 13:8-10
      3 1 corinthians 6:10; galatians 5:21
      4 colossians 3:8
      5 deuteronomy 18:9-14; galatians 5:19-20
      6 1 thessalonians 4:1-8
      7 hebrews 13:4
      8 exodus 20:14,17; 1 corinthians 6:9-11
      9 leviticus 18:22;20:13; 1 corinthians 6:9-11; romans 1:24-32
      10 leviticus 6:2-7
      11 exodus 20:15; ephesians 4:28
      12 matthew 23:25-28
      13 1 timothy 4:12
      14 1 corinthians 6:12-20
      15 romans 14

    • Deposit Information

      Upon signing this form, you agree to pay an initial deposit of $500 per applicant that is non-refundable. This deposit can be paid directly to Healing Nations unless you are a member of a church team in which case this deposit will be collected by your church.
    • Must be signed by a parent or legal guardian if under the age of 18. By signing above, I declare that all information disclosed in this document is correct to the best of my knowledge. I have read and agree to the Project Waiver/Liability Release, Code of Conduct, and Crisis Policy and am in compliance with all documents and statements therein.

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    Healing Nations is a subsidiary of Global Missions Group which is a registered 501(c)3 non-profit organization in the United States

    All donations are tax deductible as allowed by law
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