2026 Participant Form

Be The Neighbor Participant Form
For those who are 18 years or older, this should be completed by you, the participant.

For those who are 17 years old or younger, this form will need to be completed by a parent or legal guardian of the youth participant and will require signatures from both the youth participant and a parent or legal guardian.

The form includes: Participant Information, Emergency Contacts, General Health History, Assumption of Risks and Agreements of Release and Indemnification, and Be The Neighbor policies
Group Registration Number
If you don't have this number from your Group Leader, you can find it by copying and pasting this link into your browser: https://docs.google.com/spreadsheets/d/1Ja-6Im_Uuijg-_THlPfIb-MEi34GZoaR/edit?usp=sharing&ouid=109704466505440926852&rtpof=true&sd=true
Name of Congregation/Group:
There are many groups with similar names. Please make sure you are selecting the correct one.
Trip Leader's Name
Please name only one person.
Trip Leader's Email Address
example@example.com
Be The Neighbor Trip Location
Week of Be The Neighbor Trip
Start Date of Trip

MonthDayYear
Date
End Date of Trip:

MonthDayYear
Date
IMPORTANT: This is a legal document. Please read thoroughly.

Participant Information
Participant's Role on Trip
Legal Name of Participant

First NameLast Name
Preferred Name
If different than legal
Preferred Pronouns

Other
Current Grade or Grade Completed at Start of Trip
Participant's Birthdate

MonthDayYear
Date
Participant's Email
example@example.com
Participant's Cell Phone
Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState Abbreviation

Zip Code
State

Important Contacts
Emergency Contact (other than parent/guardian for youth)

First NameLast Name
EC Relationship
EC Cell Phone
Format: (000) 000-0000.
Parent/Guardian 1 Name

First NameLast Name
Parent/Guardian 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email
example@example.com

Be The Neighbor Waivers, Policies, and Covenant
- By making my selection below, I am either granting or denying permission to Be The Neighbor the right to use, reproduce, and/or distribute photographs, films, videos, and sound recordings of myself without compensation or approval rights, for use in materials created for purposes of promoting activities of Be The Neighbor.
- Photo Release Selection
- Photo Release Signature
- Be The Neighbor asks that if you have a fever before the trip, you stay home until you are 24 hours fever-free. If you develop a fever while on your trip, we'll have you isolate and work with your Group Leader and Site Director to determine the best course of action, which could include wearing a mask or possibly needing to go home early. We will do this in an effort to best protect all of the neighbors that we're partnering with!
  
  Policy Updates
  Be the Neighbor reserves the right to modify health protocols, as necessary. We will keep participants and parents/guardians informed of any changes to ensure the health and safety of everyone.
- I have read and agree to the Health Protocols and Policy outlined above.
- For and in consideration of the services of Be the Neighbor the undersigned acknowledges and agrees as follows:
  
  Be the Neighbor experiences include partnering with independent social service and ministry organizations and participating in a number of activities, including but not limited to provision of direct social services, hot meal preparation, cleaning, gardening, construction, painting, repairs, and other activities specific to a particular program. The same elements that contribute to the unique character of these activities also can cause loss of or damage to personal effects, emotional trauma, or major or minor injury/illness, death, sickness or disease, including COVID-19.
  
  Participants will meet at a church facility and must be transported to and from activity sites; therefore, it will be necessary to travel by motorized vehicle on public roads. Participants are responsible for their own safety and the safety of other group members. Trip Leaders are ultimately responsible for safety throughout the event. Be the Neighbor staff may not always be present or immediately available.
  
  I acknowledge and understand there are inherent risks associated with Be the Neighbor activities. I will assume the risk associated therewith, whether known or unknown to me at this time. I release Be the Neighbor, its employees, agents, officers, directors, and partner organizations from responsibility for accidental physical injury, including death or illness, including, without limitation, COVID-19, and loss of personal property during a be the neighbor week. I further release Be The Neighbor from any causes, claims, suits, liabilities, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, made by myself, family, estate, heirs, personal representative or assigns, now or in the future.
- Acknowledgment of Inherent Risk Waiver and Release Signature
- Name of Participant
  
  First NameMiddle NameLast Name
- I, the undersigned, do hereby authorize Be the Neighbor and its agents or representatives to consent, on my behalf, to any medical/hospital care or treatment (including locations outside the U.S) to be rendered upon the advice of any licensed physician.
  
  I agree to be responsible for all necessary charges incurred by any treatment rendered pursuant to this authorization, including but not limited to hospital, doctor, ambulance, or medical fees.
  
  I further agree that in giving this permission and authorization, Be the Neighbor does not assume any responsibility or liability for the payment of such hospital, doctor, ambulance, or other medical fees that may be incurred.
  
  I am eighteen years of age or older, have read the above authorizations, and confirm that the information contained therein is true and accurate.
- Authorization for Treatment Signature
- By signing up to attend a Be The Neighbor trip, you are agreeing to do the following:
  
  I will treat all other youth and adult participants with respect. I understand that differences in beliefs/opinions may arise in group discussions. I will listen, seek to understand, and express my beliefs/opinions in ways that do not belittle others.
  
  I will treat service partners and their clients respectfully by carefully listening, following instructions, and by fully engaging in the volunteer activity. I will always stay in designated areas at all times and will not go anywhere alone.
  
  I will treat guest leaders with the utmost courtesy and respect by listening attentively and participating in conversation only when asked to do so by the guest leader.
  
  I will respect the property of the host congregation by staying only in Be The Neighbor designated rooms/areas, by keeping the facility clean, by conducting myself calmly and quietly around others in the building, and by immediately reporting any accidental damage.
  
  I will do my best to participate in all scheduled activities.
  
  I will never leave the group without the permission of an adult leader.
  
  I will not use obscene or abusive language and I will not engage in reckless behavior that could cause harm to myself or others.
  
  I will use my cell phone only when necessary and not at service sites or during group activities.
  
  I will not have in my possession fireworks, firearms, illegal drugs, weapons, or alcohol. I understand that these activities will not be tolerated and that local police will be called, if necessary.
  
  I will not use or have in my possession tobacco products or vapes.
  
  I will not engage in any sexual activity or harassment, including comments, gestures, or physical contact.
  
  I will respect and abide by the dress requirements of our service partners.
- Covenant Participant Signature
- Covenant Parent/Guardian Signature
- Should be Empty:

Be The Neighbor Participant Form

Participant Information

Important Contacts

Health Information

Be The Neighbor Waivers, Policies, and Covenant