Mission Trip Waiver And Release Form
Download a blank fillable Mission Trip Waiver And Release Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Mission Trip Waiver And Release Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Mission Trip Waiver and Release Form
Sponsoring Organization: Lord of the Valley Lutheran Church, Granby, Colorado
Physical address: 63294 US Highway 40
Mailing address: PO Box 843, Granby, CO 80446
Coordinator: Carmen Covington
Description of Activity: Evangelism in conjunction with Memorial Lutheran Church Cacauli, Nicaragua and Dental &
Optical Clinics in villages surrounding Somoto, Nicaragua and Adobe Home Construction in Cacauli Nicaragua July
___________through August ________.
Participant Information
Participant Name: ____________________________________________________
If you are under 18 years provide name of Parent / Guardian:___________________________________________
Address: ____________________________City: ___________ State: ____________ Zip: _________
Phone (day): _____________________(eve): ___________________
Email: ________________________________________________________________
Is coordinator or designee authorized to approve medical treatment? Yes No
Is participant covered by personal/family medical insurance? Yes No
If Yes, name of Insurer: _________________________Policy or Group#_____________
Emergency Contact: _______________________________________________________
Phone (day): _____________________________(eve): ___________________________
Email: ____________________________________________
Participant Agreement
•
In consideration for the opportunity to participate in the above activity, the participant (or
parent/guardian if participant is a minor) acknowledges and accepts the risks of injury
associated with participation in and transportation to and from the activity.
•
The participant (or parent/guardian) accepts personal financial responsibility for any injury
sustained during the activity or during the transportation to and from the activity.
•
Further, the participant (or parent/guardian) promises to indemnify, defend, and hold harmless the activity sponsor
or its agents, employees, volunteers, or any of its representatives (collectively referred to hereinafter as the
“Coordinator”) for any injury related directly or
indirectly out of the described activity or transportation to or from the activity, whether
such injury arises out of the negligence of the Sponsor or otherwise.
•
If a dispute arises over this agreement or any claim for damages arises, the participant (or
parent/guardian) agrees to resolve the matter through mutually acceptable alternative
dispute resolution process.
•
If the Participant (or parent/guardian) and the Sponsor cannot agree upon such a process, the dispute shall be
submitted to a three member arbitration panel of the American arbitration Association for final resolution.
Participant Signature: ____________________________________
Date: _____________________
Parent/Guardian Signature (if Participant is a minor): _________________________
Date: ______________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal