Mission Trip Selection
2019 Kenya Fire Training November 13-24, 2019
2019 Zambia Fire Training October 23 - November 3, 2019
2019 Kenya Social Services Trip November 6-17, 2019
2019 Ukraine Fire Training August 2-12, 2019
* Home Address
Passport Expiration Date
Passport Expiration Date
(*if your current expiration date is less than 6 months after the return date of the mission, please renew your passport)
Golf Shirt Size
You will be provided 2 AFM Golf Shirts for training days on the mission trip. If you are a returning member and do not need more shirts, please indicate.
Add Safari (Kenya only)
3 day 2 night Safari to Maasai Mara or Amboseli National Park (includes transportation, lodging, food & park fees). *additional cost, $675 due with final payment (KENYA ONLY)
Frequent Flyer Information
TSA Precheck information
Emergency Contact Name
Emergency Contact Email
Emergency Contact Phone
* Emergency Contact Phone
Insurance Beneficiary -relationship to applicant
Insurance Beneficiary Address
* Insurance Beneficiary Address
When was your most recent trip with AFM?
What impact do you hope to make this year with Africa Fire Mission?
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.
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. 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?
Yes, I agree
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’s 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 which are will be used for the costs of this trip.
-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.
Yes, I agree
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?
Yes, I agree
I agree that this application is complete and accurate. By submitting this I am electronically signing the agreements within the application.
Yes, I agree
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