EMT Application - DOVE USA

EMT 2021 STUDENT Application

Welcome, we are glad you have elected to apply for EMT (Evangelistic Missions Training). This application will take you between 15-30 minutes along with a parent or guardian, we encourage you to be thorough in each section so that we can get to know you, and determine whether this experience is right for you. This 8-day immersive experience in Reading, PA has been designed to challenge you to live like Jesus. We guarantee this camp will push you out of your comfort zone, but you will also find yourself full of life as you step out, it's what Jesus promised his followers! This camp is not for the light-hearted! It will stretch you physically, emotionally, spiritually, and mentally. If you have any level of uncertainty, please consult your youth leader or e-mail us at before continuing. At the same time, nobody can ever be totally prepared to follow Jesus...sometimes you have to just 'drop your net' and say 'yes' 🙂 We hope to see you there!

I am applying for (please select one):*
- Phase 1 only (July 30-Aug 3); TOTAL COST: $270
- Phase 1+2 (July 30- Aug 7); TOTAL COST: $370
I understand that I will be charged a $50 application fee at the conclusion of this application.*
- Yes
- No
You will be redirected to PayPal for payment after you hit "Submit". Applications that are submitted without payment will NOT be received. The $50 application fee is counted towards your final payment. The final payment will be due at check-in on July 30th. (Ex. If you've elected to attend Phase 1+2, your final payment will be $320). Please note that if you've been accepted to the camp and back out, DOVE USA will not reimburse the $50 fee. If you are not accepted to EMT, we will reimburse the $50.
2021 EMT Application Fee*
Price:
Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender*
- Male
- Female
Birth Date of Applicant:*
MM slash DD slash YYYY
Age at time of camp:*
Please note that the recommended age for EMT is 13-18. If you are not 13-18 and would like to apply, please contact before proceeding. Thank you.
Applicant Email (if they have one):
Applicant Phone (if they have one):
Home Church:*
(IF APPLICABLE) If you were invited by a friend to EMT and you are not part of a DOVE Church, what is your friend's name?
This helps us stay organized and know who invited you! Thank you.
(IF APPLICABLE) If you were invited to EMT by a friend, what is the church your friend attends:
This helps us to know which DOVE Church you are attending EMT with! Thank you.
Parent Name 1:*
First Last
Parent Name 2:
First Last
Parent Phone (Primary)*
Parent Phone (Back Up)
Parent E-mail:*
Applicant T-Shirt Size:*
Has the applicant ever attended EMT before?*
- Yes
- No
Youth Leader Information

Please use the following list for reference. If your youth leader and e-mail is not listed here, please manually enter it below. If you do not have a youth leader, please enter "". Thank you.

Last Name:	First Name:	Church:	Email Address:
Breneman	Keith + Jackie	DOVE Westgate Church (Junior High)
DeMatos	Lee + Theresa	Indian Lake Community Church
Eberly	Ryan + Jen	VibrantChurch
D'Angelo	Tony	Abundant Harvest Church
Good	Gray & Beth	DOVE Christian Fellowship Elizabethtown
Good	Josh & Alissa	DOVE Westgate Church (Senior High)
Good	Shane & Sierra	Newport Church (Junior High)
Handley	Bob + Jennifer	Calvary Worship Center
Hemphill	Jonathan	Perry Hall Worship Center
Holmberg	Andrew & Fran	Broadlands Community Church
Huerta	Daniel	Overflow Community Church
Hughes	Travis + Steph	DOVE Church Wilmington
Imchen	Olivia	New Life Church
Martinez	Joey + Jenny	The Well
Elliott	Marcus and Trisha	Agape Community Fellowship of Marysville
Nichols	Peet + Kelsea	THE HIVE
Payne	Nick + Emily	Crossroads Community Church
Mellinger	Josh	DOVE Rivers of Life Fellowship
Reiff	Gary + Bonnie	Ignited Generation
Reigel	Aaron	The Fireplace Christian Fellowship
Sauder	Shawn + Andrea	Newport Church (Senior High)
Serrano	Sarai	Centro de Formación La Gran Comisión
Martin	Rachel	Freedom Lighthouse Ministries
Witmer	Josh	The New Initiative Youth Group
Yerger	Mike + Crystal	DOVE Christian Fellowship Lebanon

Youth Leader(s) Name*
First Last
*If you are not part of a DOVE youth group, no problem - just place "N/A" in this field. If you are attending with a friend who attends a DOVE Youth group please place the youth leaders name in the field, OR your friends name if you are unsure of the leaders name.
Youth Leader(s) Email*

*If you are not part of a DOVE youth group, no problem - just place "" in this field. If you are attending with a friend who attends a DOVE Youth group please place the youth leaders e-mail in the field, OR "" if you are unsure.
Medical/Insurance Information
Name of Insurance Carrier:*
Member Name*
First Last
Policy #:*
Physician Phone #
What medical or physical limitation should we be aware of that may effect your participating in any activity? (This information will be kept confidential)
Check the box of any of the following that apply to you:
- Allergies
- Asthma
- Diabetes
- Dizziness or fainting
- Eating Disorders
- Epilepsy
- Hay Fever
- Bee/Wasp Reaction
- Heart Trouble
- High Blood Pressure
- Mental/Nervous disorders
- Penicillin Allergy
- Physical Handicap
- Respiratory problems
- Operation within last year
- Other (please explain)
If you selected 'Other' in the above question, please explain:
Do you currently take any medications? (If yes, please list the medications and condition being treated)
Parental Consent
If you are under 18 years, your parent or guardian must complete the following:
Consent to Attend*
My child has my permission to attend EMT in Reading, PA at Rosedale Camp in the summer of 2021.
Medical Consent*
I agree to the following statement.
I consent to emergency medical treatment deemed necessary in the unlikely event of an accident. I will pay for any and all expenses incurred should insurance not cover them. I also release DOVE USA, the host ministry and staff from any liablility resulting from any accident or illness. I will take full financial responsibility for costs inccured if my child needs to be sent home due to an emergency or misbehavior.
Parental Release and Indemnification Agreement*
I agree to the following statement.
DOVE USA, a Pennsylvania nonprofit organization with offices at 11 Toll Gate Road, Lititz, PA 17543 runs its Evangelism Missions Training (EMT) in accordance with policies and values of DOVE USA. EMT occurs at Rosedale Grove, 1616 Vine Street, Laureldale, PA 19605.

We, the undersigned parent(s) or legal guardian(s) execute this Parental Release and Indemnification Agreement (Agreement) for and on behalf of the application-identified Child. We affirm that we hold legal status of parent or legal guardian of the Child. We understand that for the Child to participate in the EMT and outreach programs, all parents and legal guardians of the Child shall execute the Agreement.

We do hereby authorize drivers and personnel to transport the Child to and from EMT and outreach activities, as DOVE USA may elect to provide such transportation from time to time, although DOVE has no obligation whatsoever to provide such transportation. We agree that the Child will abide by the policies established by DOVE USA, and as enforced by DOVE USA in its sole discretion. We understand that activities such as those conducted at EMT and vehicular transportation to or from those activities are inherently risky, and pose the specific risks of serious bodily injury for participants, drivers and passengers.

Both for ourselves and on behalf of the Child, we hereby assume the risk of activities that we or the Child engages in with EMT including risks encountered in sports activities and transportation for such activites. We hereby release, discharge, and/or otherwise indemnify DOVE USA and affiliated sponsors and organizations, their employees, volunteers and associated personnel [including the owners of property and facilities utilized for the program], from and against any claim, loss or damages by or on behalf of us or the Child arising from the negligence of any DOVE personnel (including volunteers) or from our or the child’s participation in EMT activities or transportation.

We agree that to the extent we or the Child’s other parent(s) or legal guardian(s) is liable for any claim involving DOVE USA that we shall be held jointly and severally liable, together with the Child’s other parent(s) and legal guardian(s), for any liability arising from the Child’s participation in EMT activities or transportation.

We agree to assume full responsibility for any medical bills incurred, in the event any health insurance we have or do not have would fail to cover the full cost of treatment, transport, or other emergency service incurred for the Child. Should DOVE USA in its sole discretion determine that the Child must return home before the group for medical or disciplinary reasons, we hereby agree to assume any costs for such travel, including costs for meals and accommodations.
Parent/Guardian Signature:*
By signing I affirm that I am the parent or guardian of the applicant and consent to each of the above statements.
Student Consent
The student applicant should complete this section of the application.
Student Consent for Dismissal or Disciplinary Action*
I understand and agree with the following statement.
Doing any of the following is grounds for dismissal from EMT and Outreaches:
1. Using alcoholic beverages, illegal drugs, or tobacco of any kind
2. Stealing or gambling
3. Pornography
4. Displaying any level of romantic or dating relationships - this includes holding hands, kissing, etc.
5. Leaving the camp premise without permission.

Doing any of the following is grounds for disciplinary action and possible dismissal from EMT:
1. Fighting, disorderly conduct, or excessive noise
2. Using profanity or temperamental outbursts
3. Listening to vulgar music or reading inappropriate material on your phone
4. Not keeping your bed and items neat and clean
5. Disobedience to team leaders
6. Not keeping curfew
Student Signature*
By signing above I agree to the guidelines and rules of EMT. I also commit to living pure and staying positive throughout the week. I understand that this week has been designed to transform my life and I plan to give everything I have to loving God, serving the city of Reading, and loving those around me.
Personal Testimony Section
Required for both Phase 1 + 2 applicants. Please take your time on this section so that we can get to know you.
Personal Testimony*
Please share your testimony. Include how you gave your life to Christ, how long you have been a Christian, how God is working in your life, your experience with the baptism of the Holy Spirit, etc.
Why do you want to be involved in EMT this year?*
If you have attended EMT before, in what ways have you grown since your last experience? (If you have not attended EMT before, please put 'N/A')*
Phase 2 Application
This section is for the outreach phase of EMT (Aug 3-7) and will ask for your preference on specific outreach areas. All of these questions must be answered for those applying for Phase 1+2.
Please read ALL of the following:*
I understand how Phase 2 functions, I've read through each potential outreach team in the textbox below, and I understand that DOVE USA will attempt to place me on my first choice but cannot guarantee my selection due to availability and team limitations.
Phase 2 is designed to help you discover the unique gifts God has given you to build the Kingdom of God. With unique outreaches, you will have the opportunity to apply the talents God has given you to reach the world for Jesus. Do not be discouraged if you feel like you do not fit uniquely into one of these teams. We need your gifting! This is what Paul said, “ Now there are varieties of gifts, but the same Spirit; and there are varieties of service, but the same Lord; and there are varieties of activities, but it is the same God who empowers them all in everyone.” What is the point? You matter and you carry something your team desperately needs! If you are not sure where you best fit, please reach out to us at . You have an incredible purpose!

You will be placed on one of the following outreach teams based upon your answers below. Each team will have an outreach leader, who will coordinate the ministry you will do in Reading, and team leaders, who will lead you and your team in unity and growth in God throughout the outreach.

Here are the following two outreach options in 2021:
CREATIVE ARTS TEAM: This team will focus on doing creative evangelistic outreaches (ex. music, drama, art) throughout Reading, PA. The goal will be to share the love of Christ through the creative talents of the group. Applicants do not need to have experience in these areas, but they should have an interest in the creative arts and any experience is helpful.

SPIRIT-LED OUTREACH TEAM: This team will focus on hearing God’s voice and obedience! This team will not have a specific agenda, but will be simply given a budget to work with and the freedom to follow God. They will then spend the next four days in outreach around Reading, PA! Applicants should be flexible, willing to take risks, and ready to evangelize. If the term 'Spirit-led' makes you nervous, fear not, you will have a multiple adult leaders on your team who will be with you the whole time. This will be an experience you won't forget!

NOTE: DOVE USA will do the best they can to place you on your first or second choice outreach team, but you may need to serve elsewhere based upon availability and team limitations. You will be notified of your outreach team prior to the start of EMT.
Which of these outreach teams is your FIRST choice for EMT? Why is this your first choice?*
If you selected the creative arts team - do you have any background in dance, music, acting, worship? Please list as many helpful details as possible to help our team leaders plan outreaches. (ex. I have 4 years experience on guitar and I can sing a little).
Total
$0.00
Phone
This field is for validation purposes and should be left unchanged.

EMT 2021 STUDENT Application

Personal Information

Youth Leader Information

Medical/Insurance Information

Parental Consent

Student Consent

Personal Testimony Section

Phase 2 Application