Haiti Mission Trip Registration

Name

First Name Last Name

Birth Date

Month Day Year

Gender

Male Female

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

E-mail

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.

Mission Trip Commitment

I understand that by joining the Riverside mission team to Haiti from January 14-22, 2018 I will be representing Riverside Bible Camp and, more importantly, Jesus Christ during this trip. Therefore I am committing myself to a lifestyle that honors Christ in all aspects now and on this trip. I understand that this mission trip will involve a preparation process for ministry and evangelism. I will commit myself to attending mission team meetings and fulfilling my responsibilities for team ministry preparation. I also understand that once I turn in my deposit for this trip that I am committing to go on this trip and assume full responsibility for the financial costs for me to participate, which will be roughly $1300 (dependent on sleeping arrangements and airfare).

If at some point you decide not to go on this trip or are unable to go on this trip, Riverside will issue a refund or release from financial obligation if we are able to do so. Many trip costs are upfront and nonrefundable or only partially refundable. You are responsible for those costs even if you do not attend the trip.

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