TPP Adult Release (Adult)

Adult Volunteer Release
What Church or Group you are serving with?*
Full Name*

First NameLast Name
Your Home Address (not church)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number*
E-mail*
example@example.com
Birth Date*

MonthDayYear
Sex*
Shirt size (not applicable to all trips and days of service)*

Adult SmallAdult MediumAdult LargeAdult XLAdult XXL
Insurance Co.
Policy #
Group #
Family Doctor Name
Allergy and Information
We are unable to accommodate allergies in our meals, however we collect this information for reference and in case of an emergency.
Medications
Which Church or group are you serving with? Or which day of service are you serving?*
Medical Liability Release:

I, the undersigned, do hereby consent to the participation in all of The Philadelphia Project & Roxborough Church ministry events. This includes activities both on and offsite, including but not limited to mission trips and retreats. Further, I certify that I am physically fit to participate in these activities. However, in the event that I am injured or become ill I authorize the calling of a doctor and the providing necessary medical services. I understand neither The Philadelphia Project, Roxborough Church, nor the ministry staff may be held responsible for medical expenses incurred, but that such expenses will be my responsibility.
Photo Release:

I, also grant permission to The Philadelphia Project & Roxborough Church to Publish pictures & videos of myself on The Philadelphia Project website, in promotional videos, press releases, or any other form of public publicity.
Signature*

Clear
Should be Empty:

Adult Volunteer Release

Medical Liability Release:

Photo Release: