Arlington Mission Trip Registration Form I July 19-25

Participant Name (First and Last)

Parent/ Guardian Name and Phone number(if participant is under the age of 15)

Is parent accompanying child on trip (participant under age 15)?

Parent participating Parent not participating Not applicable (participant over 15)

Address

This address will receive a confirmation email

Phone

Thank you for your interest in joining one of our short-term mission trips! We are called to be the church and spread the great news of the gospel of Jesus Christ. As a church, we believe our role is to engage in telling others about Jesus both locally and internationally.

OBJECTIVE: To participate as a team member on a short-term mission trip with ONE Church and have the opportunity to see and participate in missions firsthand.

REQUIREMENTS: Each short-term mission trip participant must be in good health and in good standing with the church and community. To qualify, each participant must complete this form and be in agreement with the policies prescribed below.

MISSION TRIP RISK ACKNOWLEDGEMENT and RELEASE

I acknowledge that participation in this trip invovles risks, and may result in various types of injuries including but not limited to: sickness, bodily injury, emotional injury, and property damage. In consideration for the opportunity to participate in this trip, I the Participant (or parent/guardian) acknowledge and accept the risks of injury associated with participation in the trip. I accept personal financial responsibility for any injury sustained during the trip. Furthermore, I promise to indemnify, defend, and hold harmless the Trip Sponsor (ONE Church) and its agents, employees, volunteers, or any other representatives (collectively included hereinafter in the term “Trip Sponsor”) for any injury directly or indirectly related to this trip. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process.

I have read and agree I have read and disagree

Is the Team Leader authorized to approve medical treatment in the absence of parent/guardian?

Yes No Not applicable (parent attending)

Is participant covered by personal/family medical insurance?

Yes No

I understand and agree that I will be held financially liable for any property which is broken, damaged, or destroyed due to my own (or participating childs) negligence or by any deliberate act on my part (or my childs part) including but not limited to: graffiti, vandalism, and mishandling or misuse of tools, vehicles and equipment.

I agree I disagree

Deposit and trip fee ($50 deposit required to reserve your spot) 50.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Arlington Mission Trip Registration Form I July 19-25

Description

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