OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.

org

OHMI APPLICATION

We want to thank you for your interest in partnering with One Heart Ministries International (OHMI) and our
vision for the nation of Haiti. We look forward to getting to know you.

Purpose of Application

The Spirit of Excellence is our model.

Ephesians 4:1 Therefore I, the prisoner of the Lord, implore you to walk in a manner worthy of the calling
with which you have been called.

It is very important that we represent the gospel of Jesus Christ to the world with truth, purity, love,
selflessness and integrity. We want to make sure everyone is well equipped and prepared to serve. The
application sets up guidelines, accountability, and boundaries so that we are protected from UNNECESSARY
attacks from the enemy. Most IMPORTANTLY, it gives us a reference in hand (God forbid), in case of an in-
country situation/difficulty.

Objective

OHMI has worked in the nation of Haiti for the past 10 years. Along with local pastors, leaders, and
orphanages, we have established several projects which meet the basic needs of the Haitian people.
Because we are committed to Haiti and its people in a very focused and energetic way, OHMI sends teams
of volunteers, doctors, nurses, pastors, and counselors on a regular basis.

Goals

Our primary goal is to share the love of Jesus. Second, it is to respond to the physical need of the Haitian
people. 1. You will be working with a group of Haitian doctors in providing medical care for poor Haitians.
2. You will participate in our Annual Pastors conference. 3. You will be working with local orphanages. 4.
You will be involved in our VBS for 500 street children. 5. You will be involved in our Dry-feeding program
for local families. 6. Well be serving/working with one of partner elementary school.

Details

We will be working within the city of Port-au-Prince and the surrounding area alongside our affiliates there.

Date of Trip

Leaving: Novermber 4, 2017 Returning: November 12, 2017. We will be staying in Port-Au-Prince at the
Vila Ormiso compound.

Cost Per Person

Cost per person is $2,200. The flight will depart out of MCI (Kansas City International Airport). It will be a
very EARLY FLIGHT. Robyn Brumble (Medical Team Leader) and Tabitha Adams (OHMI Co-Director) will
be the primary administrative/organizers for all stateside details.

If you have any questions or concerns please contact:

Robyn Brumble : luv2mngrns@aol.com

Tabitha Adams: tabithagena@hotmail.com

 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

Application Form Includes:

- Financial Agreement and Policy

- Deadlines: Application/Payment
- Personal Information
- Family Information
- Emergency Contact
- Personal Evaluation
- Health Information
- Pastoral Recommendation Form
- Requirements
- Liability Release Form

OHMI Mailling Address:

One Heart Ministries International

11800 Beacon Ave
Kansas City, MO 64134
www.OHMIHAITI.org

Medical Administrator: Robyn Brumble

Robyn: 816-560-7052
Robyn: luv2mngrns@aol.com
OHMI Administrator: Tabitha Adams
Tabitha: 7737276851
Tabitha: tabithagena@hotmail.com

For any questions or concerns please contact Robyn Brumble (luv2mngrns@aol.com) or

Tabitha Adams (tabithagena@hotmail.com), they will be available to answer any questions
you might have regarding the trip and the organization.
www.OHMHAITI.org
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

APPLICATION & PAYMENT BREAKDOWN/DEADLINE

1ST PAYMENT: $50 Application Fee + completed application by: __April 20, 2017___

2ST PAYMENT: $950/per person by:__June 1, 2016___

FINAL PAYMENT: $1,200/per person by:__October 1, 2017__

IMMEDIATE TRAVELING REQUIREMENTS

Passport and ID: Make sure you check the expiration dates on your passport and any other forms
of ID for traveling. Your passport/IDs should have a year of validation before traveling.

Vaccinations: It is not mandatory, but highly recommended to update your vaccinations. Check
with your personal healthcare provider. It is recommended to update Hep A, Hep B, Tetanus,
Typhoid and Malaria.

RESOURCES: (written by a good friend and ministry leader)

The Orphan Report - By Joe Knittig

Over the last ten years, the Lord has moved many to serve children in the worlds Orphan
Window. From adoptive families, to people going on mission trips, to parachurch ministries
facilitating orphan care, to local churches caring for kids, the Orphan Awakening has reached a
tipping point. New entrants into global orphan care thirst for information about the journey
ahead. Whats the context? What should we expect? How do we move forward?

The Orphan Report ($16)

Kindle eBook on Amazon ($7.99)

The Orphan Report For Ministry Leaders ($16)

Kindle eBook on Amazon ($7.99)

If you want to learn more about Haiti, I would highly encourage each team member to grab a
copy of The Orphan Report. It offers in-depth insight into the roots of Haitis poverty and the
orphan crisis.
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

OHMI POLICIES AND STANDARDS FOR PAYMENTS

1. Financial Obligation:
A. $50 Application Fee: Please make sure the application fee comes in the form of a Money order
or a check payable to James Adams. In the memo line please write Application Fee. Please be
aware THIS IS NOT-REFUNDABLE.
B. Last Minute Cancelation: Due to in-country and states administrative expenses, there is a $350
fee for last minute cancelation. Theres a lot of preparation, time, planning that goes on both
states and in-country side. Our team on the ground works tirelessly to make sure we have
everything we need upon arrival.
Applicants that are unable to make payments at the time agreed upon WILL NOT BE ABLE TO
COME. NO EXCEPTIONS!
2. Failure to Complete Application: All applicants are required to complete the entire application
process in order to travel or participate in any of OHMI trips to Haiti. Part of the process includes
group training and bi-weekly prayer focus.
3. Airfare: Once tickets are purchased, applicants are responsible for any personal changes and
cancelations.
4. Emergency Leave: Each team member is strongly encouraged to get personal travelers
insurance. In case of an in-country medical emergency, its very important to get covered for any
critical medical assistance.
5. Early Dismissal:
A. Safety First: Our primary goal is to make sure (as humanly possible) you are safe as you serve in
Haiti. When in Haiti, if a team member is not willing to follow OHMI safety protocols, he/she will
be asked to leave.
B. Divisive/Critical Spirit: We have ZERO tolerance for any form of such behavior. Divisive and/or
critical spirits are poison, and a recipe for major destruction in a team dynamic. Any individual
that functions and/or engages in such behavior consistently will be asked to leave.
C. Early Dismissal Fee: Every team member is responsible for early dismissal fees. If at the time of
dismissal, a team member does not have the money, OHMI will lend the amount with the
understanding of complete REIMBURSEMENT once returned to the U.S.A

I have read, understood and agree to the above Terms and Standards set by of OHMI.

Signature:_________________________________________________________Date:______________
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

PERSONAL INFORMATION

Name________________________________________________Date of Birth______/______/_______

Profession_________________________________________Years in
Practice_____________________

Address_________________________________City__________________State_______Zip_________

Phone (_______)____________________E-mail_____________________________________________

Passport Number: ___________________________________________ Expiration:

________________

* International Travelers, Please check expiration dates on all documentation to travel in/out of
the U.S.A

FAMILY INFORMATION

Father/Legal Guardian:_________________________________________________________________

Mother/Legal Guardian:________________________________________________________________

Address__________________________________________________City________Zip_____________

Cell (________)________________Home (______)_____________Work

(_________)______________

EMERGENCY CONTACT

Name__________________________Cell (______)____________Email:________________________

Name__________________________Cell (______)____________Email:________________________

IMPORTANT INFORMATION WE SHOULD KNOW ABOUT YOUR EMERGENCY CONTACTS?

_____________________________________________________________________________________
____________________________________________________________________________________
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

PERSONAL EVALUATION

Please assess yourself in the following:

Uncertain Weak Good Outstanding

Spiritual maturity 0 1 2 3 4 5 6

Physical health............................ 0 1 2 3 4 5 6

Family life................................... 0 1 2 3 4 5 6

Teachability 0 1 2 3 4 5 6

Emotional stability 0 1 2 3 4 5 6

Leadership skills... 0 1 2 3 4 5 6

Reliability.. 0 1 2 3 4 5 6

Willingness to serve. 0 1 2 3 4 5 6

Communication skills.. 0 1 2 3 4 5 6

Working without supervision 0 1 2 3 4 5 6

Ability to work with others.. 0 1 2 3 4 5 6

Openness to correction 0 1 2 3 4 5 6

Self-discipline 0 1 2 3 4 5 6

Devotion to Christ 0 1 2 3 4 5 6

MUSICAL TALENTS:

Musician:

Singer:

Worship leader:
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

ADDICTIONS AND STRUGGLES

Please be specific and honest.

1. What would you consider to be your weaknesses?

2. Do you currently struggle with or are you addicted to smoking, drugs, gambling, lying
(chronic), or alcohol? If yes, please specify.

3. Do you have/struggle with any life-controlling mental, sexual, emotional or relational

issues? yes no. If yes, please explain.

4. Have you ever had any substance abuse problems or addictions? yes no If yes,
please explain.

5. Have you ever been accused or convicted of child abuse; i.e., sexual, physical, emotional
or neglect?

6. Are you in good standing with the state or national board of your practice/profession?

7. Are you involved in any inappropriate relationships; i.e., premarital relations? If yes, were
sorry, but you CANNOT participate in any OHMI ministry trips.

8. Same-Sex Relationship: We respect and love people regardless of what lifestyle they
choose to live. With that being said, we, OHMI leadership feel very strongly not to allow
individuals that practice such lifestyle to participate in any OHMI ministry trips.
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

HEALTH INFORMATION:

1. ADHD 2. Alcohol Abuse 3. Chronic Depression 4. Sexual Addictions 5. Drug Abuse 6.

Cigarette Habit Anorexia) 7. Chronic Pain 8. claustrophobia 9. Anxiety/PTSD 10. Allergies (Type)
11. Long-term Medication 12. Seizures 13. Eating Disorders (Bulimic), 14. Diabetes 15.

Other:

16. Do you have any physical disabilities or conditions that require special care? If yes please
explain.

DISCLOSURE OF MEDICATIONS
One Heart Ministries International encourages you, during your time on the trip, to maintain
your prescribed regimen of medication unless directed to change under the supervision of a
doctor.

IMMUNIZATION

I affirm that One Heart Ministries International has informed me and urged me to seek advice from
medical professionals regarding any and all immunizations/medications that the medical
professionals advise me to have prior to going on the missions trip, and One Heart Ministries
International has further advised me to receive/take all such immunizations/medications.

Should I choose not to receive these immunizations/medications, I hereby assume full

responsibility and do hereby release One Heart Ministries, FIRE International, its directors,
employees, agents, representatives, and any volunteers from any and all liability and
responsibility in connection with the missions trip.

CONSENT FOR MEDICAL TREATMENT:

In the event of an accident or injury involving myself, authorization is hereby given to One Heart
Ministries to consent to medical treatment. I will be responsible for the charges for any medical
treatment or hospitalization rendered by reason of this authorization. This permission is valid from
the start of the trip until my return from the missions trip.

Signature:________________________________________________________Date:_______________
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

PASTORAL RECOMMENDATION
NOTE: Please return this form directly to the applicant in a sealed envelope. If you have any
questions, please email us at tabithagena@hotmail.com

Your Name_______________________________________Church Name________________________

Your Position____________________________________Church Phone(______)__________________

Church Street____________________________________City_________State______/Zip___________

Contact Phone(______)__________________E-mail_________________________________________

How long and how well have you known the individual?

Please describe the individuals level of involvement in your church/ministry.

What is your assessment of the individuals ability to handle situations involving change, crisis,
and correction?

What is your assessment of the individual?

Not Observed Weak Fair Good Outstanding

Spiritual maturity 1-2 3-4 5-6 7-8 9 - 10

Devotion to Christ....... 1-2 3-4 5-6 7-8 9 - 10

Integrity and honesty........ 1-2 3-4 5-6 7-8 9 - 10

Openness to correction...... 1-2 3-4 5-6 7-8 9 - 10

Working with others.......... 1-2 3-4 5-6 7-8 9 - 10

Willingness to serve........... 1-2 3-4 5-6 7-8 9 - 10

Teachability. 1-2 3-4 5-6 7-8 9 - 10

Emotional/physical stability 1 - 2 3-4 5-6 7-8 9 - 10

 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

OHMI MISSION FIELD REQUIREMENTS

Our model: We go to serve, not to be served - Matthew 20:28, Matthew 28:19

Life of prayer and communion with God: It is critical that every individual on an OHMI ministry
trip have a consistent relationship and fellowship with God, Jesus and Holy Spirit.

Teachability: We ask every team member to have a teachable spirit. Be quick to listen and learn,
and slow to speak.

Leadership Structure: We believe in the chain-of-command reality, not in a bossy, controlling, or

power driven way but in a godly and Biblical way. Respecting and honoring those that are placed
in charge is key to effective, powerful, and safe ministry trips.

Team Unity: OHMIs greatest strength is the call to be a unit as we minister together overseas. We
strongly believe in the principle of being each others keeper. We serve one another, prefer one
another above ourselves. We cover each others weaknesses and encourage each other in our
strengths.

Beyond Reproach: In all things show yourself to be an example of good deeds, with purity in
doctrine, dignified, sound in speech which is beyond reproach, so that the opponent will be put to
shame, having nothing bad to say about us. Titus 2:7-8. We ask all team members to uphold a
clean, modest, and non-distracting appearance in how they dress for all ministry engagements.

Relationships: There is ABSOLUTELY no place for romantic relationships to be formed while on an

OHMI ministry trip. We believe romantic relationships that are formed on ministry trips are
distractions and take the focus off of Jesus and put it on oneself. OHMIs policy on this subject is
very clear: You will be sent home from any ministry trip led by OHMI if you choose to ignore this
policy.

Financial Obligation: Every team member is responsible to raise all required finances on time. If
you cannot provide your finances, you will not be able to come. We DO NOT reimburse, if for
some personal reason you decide not to come.

Giving Gifts: Team members are to NOT give cash or personal gifts of any kind to any individuals
that they encounter during their time on the mission field. One Heart Ministries International is
committed to working with communities to help meet the needs of the local people in a way that
does not create dependency or a sense of entitlement. If you are led to give, the gift must be given
directly to the One Heart Ministries International leadership team for proper distribution.

Personal Contact: No personal contact is to be made out to any individuals in Haiti. All
communication should be directed through One Heart Ministries International.

Participation: Participation is not an option. Every team member is required to participate in all
projects and team/ministry activities. Again, we go to serve, not to be served.

Fun: Fun is not an option; Its mandatory. Every team MUST have fun as they love, serve, and bless
the people of God. We will have a day of rest.
 OHMI: 11800 Beacon Ave, KC, MO 64134 www.OHMIHAITI.org

LIABILITY RELEASE FORM

As a trip participant with ONE HEART MINISTRIES INTERNATIONAL (OHMI), I understand that
there are certain dangers associ
ated with overseas and domestic mission trips (or field trips) such as illness, political unrest,
accidents, hostilities, etc.

I, _______________________________________________, hereby release OHMI and FIRE Church

(Please print clearly),

from any liability, accident, injury, illness or disease sustained or contracted by me while on an
OHMI-sponsored trip. I further agree to hold harmless OHMI and any ministries affiliated with
OHMI from any medical, hospital, or dental bills incurred as a result of any injury, accident,
illness or disease sustained or contracted by me while on any trip. Furthermore, OHMI shall not be
responsible for the loss or damage to my personal property or any personal property of another
that I may damage. OHMI shall not be responsible for any personal injury that I may cause to
happen to another person. I also agree to indemnify and hold OHMI harmless from any damages,
expenses, attorney fees or costs incurred by OHMI as a result of any conduct on my behalf while
on any such mission or field trip.

Any additional expenses incurred by me due to early dismissal or emergency leave from the
missions trip will be my sole responsibility as a trip participant.

I have read, understand, and agree to the above conditions.

Signature:_____________________________________________________________Date:__________

ONE HEART MINISTRIES INTERNATIONAL understands the need for safety precautions as it plans
short-term mission trips for the members. We will take reasonable precautions to provide a safe
opportunity for foreign missions exposure. As we plan every trip, we will work closely with
national church leaders and veteran missionaries to communicate the need for safety for trip
participants in their lodgings and their activities. However, we cannot guarantee the complete
safety of every individual on any specific trip.

We promise that we will not get involved in political activities or schedule activities that involve
unnecessary opposition. We will work closely with national church leaders or veteran missionaries
who are aware of the political climate and will follow their instructions. However, we also
understand that the very nature of our activities in preaching the Gospel of Jesus Christ is offensive
and will at times provoke strong opposition. At those times we will defer to the national leaders
and will make every reasonable attempt to protect trip participants. We also understand that at
times a country we may be visiting can erupt into violence that is impossible to predict and not of
our doing. On those occasions, we will do everything reasonably possible to protect trip
participants and remove them from the area or the country as soon as possible. In the event of a
terrorist attack that would result in a hostage situation, the policy of One Heart Ministries
International and Fire Church is that we will not negotiate with the terrorists. However, we will do
all within our power and in close cooperation with national leaders to obtain the release of any
member of our team.