CA Mission Team Member Information

CA Mission Team Member Information

All information will be kept confidential.
Name*

First NameLast Name
Which trip are you participating in?*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Country/Countries of Citizenship*
Emergency Contacts

Please provide two contacts in case of an emergency. These contacts should not be on the trip with you.
Name*

First NameLast Name
Relationship*
Phone number*
Email*
example@example.com
Name*

First NameLast Name
Relationship*
Phone number*
Email*
example@example.com
Parent / Legal Guardian Identification

If you are under 19 years of age, please upload a clear photo or scanned copy of both parents’ or legal guardians’ passports. If they do not have a passport, a government-issued photo ID (e.g., driver’s license) may be submitted instead.

Please upload one form of ID for each parent/legal guardian.
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Medical Information
Personal Health Number*
Which province issued your health card?*
Name of doctor
Doctor's phone number
Do you have any allergies, dietary restrictions, chronic illnesses or conditions?*

YesNo
Please describe.*
Do you take prescription medication?*

YesNo
Please list the name and function of each medication.*
This information will be kept confidential and only used to ensure your safety and wellbeing. *Please bring your own allergy medication and enough prescription drugs for the duration of the trip. It is best to keep medication in original packaging with labels.
Financial Policy
I understand that all funds raised are non-refundable, even if I cannot attend the mission trip*
I understand that if I don't adhere to the Team Commitment, I will be required to return home at my own expense*
Signature*

Clear
Should be Empty:

CA Mission Team Member Information

Emergency Contacts

Parent / Legal Guardian Identification

Medical Information

Financial Policy