Clone of Israel February 2027 Trip Participation Form

Israel Trip: February 2027

Please complete and submit the form below. A separate form must be submitted by each individual.

Full Legal Name (as it appears on your passport)*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail

Birth Date*

MonthDayYear

Place of Birth*

City and Country

Are you a US Citizen?*

YesNo

Gender*

MaleFemale

Driver's License Number*

Enter N/A if you don't have a driver's license

Do you have a valid US passport?*

YesNo

Passport Number*

Enter N/A if you don't currently have a passport

US Passport Expiration Date

MonthDayYear

Medical Insurance Provider

Medical Insurance Policy Number

Medical Insurance Provider Address & Phone

Enter mailing address and phone number

Medications Currently Taking

List medication name(s) and reason for taking

Allergies or Medical Conditions

List any medication allergies or food allergies or any medical conditions we should be aware of

Do you currently have seizures?*

YesNo

If yes, date of last seizure

Date of last tetanus shot*

Any other health information that would be helpful to know

Family Doctor*

First NameLast Name

Family Doctor Phone *

Area CodePhone Number

Emergency Contact 1*

First NameLast Name

Emergency Contact 1 Phone Number*

Area CodePhone Number

Emergency Contact 2*

First NameLast Name

Emergency Contact 2 Phone Number*

Area CodePhone Number

I desire to participate, or if the Participant is less than eighteen (18) years old, I give my permission for the Participant to participate, in The Sending Project trip. *

Agree

The medical information that is provided on this form is correct to the best of my knowledge. I certify that the Participant is able to participate in all activities unless I have otherwise advised The Sending Project in writing. I also certify that all medical conditions or allergies, which may limit the Participant’s participation in activities, are listed above. *

Agree

I understand that The Sending Project (TSP) will take reasonable precautions to help make experiences safe; and that despite the precautions, occasionally people do get injured or become ill. I understand that some circumstances are beyond anyone’s control. I also understand that TSP requires that the Participant be covered by a health insurance policy with coverage in the United States and abroad. We can provide you with a recommendation for low cost international trip insurance.*

AgreeI need a recommendation for international trip insurance.

IN THE EVENT MY EMERGENCY CONTACTS CANNOT BE REACHED IN A CASE OF EMERGENCY, I HEREBY AUTHORIZE THE SENDING PROJECT, OR THEIR RESPECTIVE OFFICERS, DIRECTORS, AGENTS, EMPLOYEES OR THEIR DESIGNATED MEDICAL PROFESSIONALS TO MAKE EMERGENCY MEDICAL DECISIONS (I.E. DOCTORS, HOSPITALS, MEDICAL TREATMENT, ETC.) AND/OR TO ADMINISTER EMERGENCY MEDICAL ASSISTANCE. I ACCEPT RESPONSIBILITY FOR PAYMENT OF EXPENSES INCURRED AS A RESULT OF ANY MEDICAL TREATMENT. *

Agree

I HAVE READ, AGREE TO, AND UNDERSTAND ALL THE TERMS IN THIS DOCUMENT. THE INFORMATION I HAVE PROVIDED ON THIS FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE. I AGREE THAT ALL THE TERMS IN THIS DOCUMENT APPLY TO ME AND/OR THE PARTICIPANT. THE SIGNATURE(S) BELOW SIGNIFIES APPROVAL OF ALL INFORMATION AND TERMS LISTED IN THIS DOCUMENT. A COPY OF THIS PARTICIPATION FORM MAY BE TREATED AS AN ORIGINAL EXECUTED COPY FOR ALL PURPOSES.*

Sign your name above with finger or mouse

Date*

MonthDayYear

State

Enter name of the State where this document is signed

County

Enter name of the County where this document is signed

Mother/Guardian's Signature (if participant is under the age of 18)

Sign your name above with finger or mouse

Date

MonthDayYear

Father/Guardian's Signature (if participant is under the age of 18)

Sign your name above with finger or mouse

Date

MonthDayYear

The Sending Project Trip Participation Form