Mission Trip Sign Up Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Departure Date
-
Month
-
Day
Year
Date
Preferred Return Date
-
Month
-
Day
Year
Date
Mission Trip Name
Organization Name
Why do you want to be a part of this mission trip?
Purpose Of The Mission Trip
Skills or Experience Relevant to the Mission Trip
Church Affiliation
I,
First Name
Last Name
, hereby agree to participate in the
Mission Trip Name
organized by
Organization Name
, and I hereby acknowledge that there are certain risks and dangers associated with this activity. I acknowledge that these risks include, but are not limited to, injury, illness, and death, as well as loss or damage to personal property.In consideration of being permitted to participate in this activity, I agree to assume full responsibility for any risks, injuries, or damages that I may sustain, or that my property may sustain, as a result of my participation in this activity. I agree to release, waive, discharge, and hold harmless
Organization Name
, its officers, directors, employees, and agents, from any and all claims, damages, or liabilities that may arise out of or in connection with my participation in this activity.I further agree to indemnify and hold harmless
Organization Name
, its officers, directors, employees, and agents, from any and all claims, damages, or liabilities that may arise out of or in connection with my participation in this activity, including but not limited to, claims made by third parties.I understand that this Liability Waiver and Release Agreement is a binding legal agreement, and I sign it voluntarily and with full knowledge of its contents. I acknowledge that I have read and fully understand the terms and conditions set forth in this agreement.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: