Team Member Registration & Consent

Team Member Personal Information

Team Member's Name *

First Name Middle Name Last Name

Team Member's Birth Date *

Month Day Year

Team Member's Gender *

Male Female

Team Member's E-mail *

example@example.com

Passport Information

Type of Passport *

I have a valid US Passport I have applied for a new or renewed passport. I have a passport from another country. Other

PLEASE NOTE: Your passport must have an expiration date of more than six months after your travel dates. For example, if you plan to travel from Janaury 2 through January 9, your passport must not expire before July 9 of that year.

If you travel on a Passport from another country, what country?

Passport Expiration Date *

Date of Expiration for passport (MM / DD / YYYY)

Please provide a copy of your passport and any other relevant travel documents to your team leader as soon as practical.

Contact Information

Team Member's Address

Street Address

Street Address Line 2

City State

Zip Code

Home Number

Cell Number

Mission Trip Information

What is your mission destination? *

To what country will your mission team travel?

What is your desired work on the trip? *

What kind of work will you do while traveling?

Start Date of Your Trip *

Travel Date (first day of trip)

Name of Team Leader (if you know it)

Church Information

Name of The Church That Is Sending the Team *

This is the primary church that is leading the coordination of the mission team.

Your Church Relationship *

Your Church's Name *

Your Pastor's Name *

First Name Last Name

Your Church Phone Number *

Please enter a valid phone number.

Emergency Information

Do you have food allergies, medical allergies or any special medical issues? (Please check all that apply) *

I have no food allergies I have no medical allergies I have no special health concerns See below for Allergies and Health Conditions

Details of Food Allergies, Medical Allergies, or Special Health Issues or Conditions

Emergency Contact Name *

First Name Last Name

Emergency Contact Relationship *

Emergency Contact Phone Number

Emergency Contact Email

Primary Care Physician Name *

First Name Last Name

Primary Care Physician Phone Number

Please enter a valid phone number.

Health Insurance Information

Healthcare Insurance Carrier *

Healthcare Insurance Policy Number *

Health Insurance Carrier Phone Number

Please enter a valid phone number.

Type of Insurance *

Employer Provided Plan Private Insurance or Marketplace Plan MediCare Plan I do not have a Health Insurance plan listed above. (Check here if you only have VA plan, Health Share Plan, Medicaid or targeted supplemental plan)

HEALTH INSURANCE IS REQUIRED FOR TRAVEL. The policies listed above (VA plan, Health Share Plan, Medicaid, and targeted supplemental) do not meet the requirements to be insured for evacuation insurance. If you need to purchse a policy that allows you to travel with this team, please contact Suzanne Munson at suzanne@isabrokers.com or by phone at 800 647-4589, ext. 217 for additional acceptable coverage while you travel.

Informed Consent and Acknowledgement

Mission On The Move has adopted the following guidelines. We have established them based on the culture in the areas where we serve in order for you to provide the most effective witness possible in a short trip. As such, please respect them and abide by them understanding they may not reflect your style and personality. It is extremely important to be willing to adjust to the expectations of the host church, the host culture, the missionary, and the Team Leader. Your decision to go should be done after prayer and consultation with your family and your pastor.

Therefore, in consideration of the permission granted to me by the M.O.M. organization to participate in the above-described project during the above dates of the mission, and in consideration of the other obligations incurred by the mission organization during this mission activity, I hereby agree as follows:

I agree to share my faith in an appropriate manner while on the mission.
I agree to abstain from the use and/or purchase of alcohol and tobacco while on the total experience of this mission. The use of alcohol and tobacco in Latin America is taboo and would destroy the effective witness of a volunteer team.
I hereby release and discharge the mission organization, Mission On The Move, its agents, employees, and officers, from all claims, demands, judgments, and executions which I ever had, or now have, or may have, or which my heirs, executors, administrators, or assigns may have, or claim to have, against the mission organization, its agents, employees and officers, and its successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or arising out of the above-described mission activities.
I hereby acknowledge that by engaging in the above-described mission activities, I am subjecting myself to certain risks, including and in addition to those which I normally face in my personal and business life, including but not limited to such things as health hazards due to poor food and water, infectious diseases, pests, and poor sanitation; potential injury while working; and inadequate medical facilities, etc.
I agree not to give any cash or gifts to any particular National without the approval of the Resident Missionary. I also agree not to make contact with any Nationals after the departure of the Team for the purpose of giving cash or gifts without the approval of the Director of Mission On The Move and the Resident Missionary.
I agree not to give any invitation to any National to return with the Team to the United States or even to imply that arrangements will be made for a visit or permanent stay in the U.S.
I agree to pay in full my portion of the mission no later than thirty (30) days prior to the date of departure.
I agree to cooperate at all times with the Resident Missionary & Team Leader concerning the work assignments, the Dress Code, the Child Safety Rules, the food, lodging, and accommodations provided for the team and to stay with the team from beginning to end.
Failure to follow these rules may result in being asked to leave the team or the mission at your own expense.
I have received a copy of the Dress Code For Mission Teams and the Team Member Basic Child Safety Rules and agree to follow them to the best of my ability. I have read and understand the rules outlined for interacting with the children in the care of Mission On The Move and agree to abide by them.
I agree to wear a mask and social distance based on the requirements of the local government and the local missionaries for the protection of myself and/or those we are near.
I agree that any in-country expenses that could arise are my personal financial responsibility including but not limited to uncovered medical expenses and expenses related to a COVID quarantine.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Signature below confirms that I have read this release and that I understand all of its terms. I execute it voluntarily and with full knowledge of its significance. *

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Mission On The Move Team Member Profile