• Vinton Baptist PASSPORTkids Mission Trip

    June 10-13 at Eagle Eyrie Conference Center
  • Participant Details

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  •  - -
  • Cost for the weekend is $200. Deposit Payment will be made by: *

  • $100 deposit due on April 20th
    $100 final payment due on May 1st 

  • If paying online, please go to: Vintonbaptistchurch.org/give
    -Select One Time gift
    -Passport Kids Summer Trip
    -Please include your student's name in the memo line

  • Emergency Contact

  • Format: (000) 000-0000.
  • Emergency Contact 2

  • Format: (000) 000-0000.
  • Medical Details

  •  - -
  • Policy Holder Address (if different from student):

  • Format: (000) 000-0000.
  • Registration Confirmation

  • By the issue of this letter I am authorizing the transportation, lodging, and feeding of participant named above. Should a medical emergency arise during a church activity or while traveling on such, I hereby grant permission to the activity leader or adult chaperone(s) to make whatever emergency arrangements are necessary, including the selection of physicians, paramedics, or other medical personnel and a hospital and/or clinic for the care of participant named above. I hereby give the medical personnel, hospital, and/or clinic my permission to hospitalize, treat, and to order injections, blood, anesthesia, or surgery as required for participant named above. I also understand that as a participant, my child may be photographed or videotaped during on- and/or off-campus activities, and these photos/videos may be used in promotional materials, group activities, and/or official church website. I, the undersigned, do hereby release and forever discharge Vinton Baptist Church, its employees, agents, and members from any and all claims past, present, and future, arising out of any illness or injury to participant named above. Further, I assume full financial responsibility for all physician, technician, medical, hospital, or other fees charged for such treatment.
  • Clear
  •  - -
  • I do hereby give my permission for myself and or my child to receive emergency medical care. In addition, I will not hold Passport, Inc., the host campus, or any mission partner agency responsible for any expenses, claims, or liabilities arising from any sickness or injury to my child or to me. In addition, I grant myself/my student the right to participate in any activities at/during camp. Finally, I understand that Passport, Inc. may use images of all camp participants on projection screens at camp and in future promotional materials. A parent or legal guardian must e-sign for any participating minor and agree that they and the minor are subject to all the terms set forth above.
  • Clear
  •  - -
  • Electronic Consent

  • Image field 65
  • Should be Empty: