Form For Summer Camp Mission Trip | Touching Lives World

Touching Lives Worldwide

Application for Team Member on Dominican Summer Camp

Personal Information

Name (Exactly as it appears on your passport).

Multi-line address

Country/Region

Address

City

Zip / Postal code

Home Phone

Cell Phone

Marital Status

Married

Unmarried

Birthday

Month

Day

Year

Passport #

Passport Expiration Date

Month

Day

Year

Upload Passport Information Page

Health Information

Describe your general health condition.

List any medications you are taking.

List Allergies

Name of Primary Care Physician

Primary Care Physician's Phone #

List any physical limitations that may affect your ability to participate in all or some of the mission activities or which will require some special accommodation.

Travel Insurance Purpose: Name a Beneficiary or type "My Estate"

Name of emergency contact person

Emergency Contact Person's Phone #

General Information

Have you been on a Summer Camp Mission trip with Touching Lives before?

Yes - but I would like to complete the interest portion of this form again.

Yes - Please skip to the signature.

No - You must complete all the following questions.

Have you been on any mission trips? If so, please summarize your experiences.

What is your primary interest or purpose in this trip?

What skills or gifts do you have that could be useful on this trip? What do you like doing?

Please share any other information about yourself that would be helpful and share what you hope God will do in and through you during this mission trip.

By signing below, you certify that the information you have provided is accurate and acknowledge that you are solely responsible for all expenses related to your participation (travel, lodging, food, and miscellaneous costs).

Signature

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Waiver and Release of Liability

In signing this form, I,

Your Name

I agree to not hold TOUCHING LIVES WORLDWIDE, INC. its officers, associates, or other agents of the entity named above, liable for any injury, loss, damage, or accident that I might encounter while on a short- term mission team that they are helping to facilitate. I realize and

acknowledge that my participation on a mission trip includes many risks and possible dangers. I am well aware that my travel exposes me to such risks as accidents, disease, war, political unrest, injury from construction projects, and other calamities. I hereby assume any such risks that might result from my travel and/or participation in a mission project and I

unconditionally agree to hold TOUCHING LIVES WORLDWIDE, INC., its officers, associates, or other agents blameless for any liability concerning my personal health and well being, or any liability for my personal property that might be lost, damaged, or stolen while on a mission

trip.

I have read the foregoing and I understand that my signature herein holds the above mentioned entity, its officers, associates, and other agents of it, harmless for any liability for injury, damage, loss, accident, delay, or irregularity of the schedule. I waive any and all liability for personal injury damages and property damages that I may suffer while participating in the mission to any place which involves the above entity. This waiver and release is binding on the undersigned mission member, his or her heirs, assigns, executive and personal representatives.

In addition, I agree that my behavior will not hinder this Christian ministry. I understand that if I do something that violates this agreement, then I may be dismissed from service and may be required to return home early at my own expense.

Date

Month

Day

Year

Signature

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Printed Name