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Midland Evangelical

Free Church

Worship @ 9:00 & 10:45 AM

The Portal

Xtreeme Student Captain Application


Hello, thank you for your interest in being an X-treeme Student Captain. 

Please complete this form to apply to be a Student Captain. Also, please DOWNLOAD THIS PACKET to help clarify the expectations of being a Student Captain.  Please read through this and complete the application (online) if God is moving you to this next step in your journey with Christ.

Love, Pastor Jeff


Briefly share how you became a Christian, and describe how your relationship with God is currently doing?
What non-Christian friends are you praying for and desiring to share your faith with?
How would your non-church friends describe your relationship with God?
In your own words, what are the major responsibilities, expectations and time commitments of a person involved in Student Captain Ministry training?
Briefly share why you want to be a part of this ministry training at Midland Free?
List your involvements like sports, drama, band/music, clubs, jobs etc., throughout the school year:

Let’s do it!  I have a personal relationship with Jesus Christ and live by faith, following his example and obeying his commands in the Bible.  
*Name of Mentor:
*Does your mentor attend Midland Free?:
¨      I am ready to commit to be involved in ministry training with Xtreeme.  
¨      I will commit to regular church and X-treeme attendance.
¨      I will commit to modeling a healthy commitment to my family
¨      I commit to a lifestyle as a role model and ambassador of Jesus
¨      I commit to being a light for Christ on my campus, workplace, in my neighborhood and in my home.
¨      I understand I am committing to:o  Actively feeding my relationship with Jesus through daily personal worship.
o  Being involved with developing and leading X-Prayer once a month.
o  Memorizing God’s word.
o  Getting a Mentor and completing the Mentoring GRHHA (see last page)
o  Attending monthly training meetings
o  And I have read over the information in the Student Captain Ministry Training Application packet.

*Name of Parent giving consent:


Name(s) of parent/guardian if participant is a minor:
Parent/ Guardian Telephone:
*Name of emergency contact:
*Emergency Contact Telephone:

Medical Consent
I hereby authorize Midland Evangelical Free Church (MEFC) and/or activity coordinator to approve medical treatment if necessary.
*Does the participant have any Life Threatening allergies and/or medical conditions?:
If yes, list allergy/condition:
If yes, list reaction:

If the participant is covered by personal/family medical insurance:
Name of insurance provider:
Policy or group number:

Photo/Video Consent
I hereby assign and grant MEFC the right and permission to use and publish/exhibit any photographs/film/video/electronic representations and/or sound recordings made of said participant while participating in the above mentioned activity.

Physical Injury Hold Harmless Agreement
The participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity listed above.  Except for gross negligence on the part of MEFC, the participant (or parent/guardian) accepts personal financial responsibility for any injury sustained during the activity. 

Safety of Children Hold Harmless Agreement 
MEFC’s Safety of Children Policy as stated in Section II of the Facility Use Agreement (available upon request)  requires two background checked and approved adults to be present in the company of children under 18 years old, and all participants stay in open and clearly visible areas during the activity.  The participant (or parent/guardian) acknowledges and accepts that this policy may not always be adhered to during this activity.

By signing below, the participant (or parent/guardian) accepts full responsibility for any injury sustained and for the care and safety of the participant during the activity listed and as outlined in the Consents and Agreements above. The participant (or parent/guardian) agrees to indemnify and hold harmless MEFC, its staff, members and Board of Elders against any liability or legal action that might result from any injury or loss suffered by the participants if loss or injury is a consequence of participation in the activity.  This includes any expenses, damages, liabilities, losses, actual attorney’s fees and and/or judgments arising out of or in connection with, any claim, demand or action made by any party as a result of the activity or event. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through arbitration.

*Electronic Signature (Participant or Parent/ Guardian if participant is a minor):
*Email (Participant or Parent/ Guardian if participant is a minor):
If you would like to request a copy of this Agreement please contact the MEFC office at 989-631-4411.