Name (the name you perfer to be called) *

First Name

Last Name

Cell Phone # *

(###)

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Fields of Interest (Multiple Choices)

Multiple fields can be chosen. The mission leaders, however, might assign different ministries to you based on the need.

Driving (15-passenger VAN)

Kids

Sisters

Brothers

Cooking

Light Construction

Release of Liability and Consent to Treatment *

While I intend to participate in Mexico Mission ministry and related activities sponsored by EMCI and partner churches, I am aware of the inherent hazards and dangers associated with such involvement. Therefore, in recognition of the privilege extended to me by EMCI and partner churches, their officers, agents, servants, and employees, I hereby release and discharge them, along with all associated individuals acting officially or otherwise, from any and all actions, claims, demands, injuries, illnesses, damages, losses, or deaths that may occur during participation in said events. I understand that participation in the mission trip entails exposure to various risks and dangers, including but not limited to travel, overnight stays, safety hazards, criminal activities, health risks, accidents, and potential encounters with violent individuals or groups. I acknowledge these risks as inherent to voluntary participation in the program. Furthermore, I agree to indemnify and hold the churches harmless from any actions, claims, suits, expenses, damages, or liabilities arising from my involvement in the program and to reimburse them for any related expenses incurred. I hereby authorize the leadership of the mission team to consent to any necessary medical procedures or treatments deemed advisable by licensed medical professionals. This authorization extends to any hospital providing treatment to the team member, with the understanding that the decision-making authority lies with the appointed agent. This authorization remains effective until revoked in writing and delivered to the designated agent. By signing below, I confirm that I have read, understood, and agreed to the terms of this release.

I agree to the liability and consent to treatment

Name on passport or green card (for mission trip insurance) *

First Name

Last Name

Date of birth (for mission trip insruance) *

MM

DD

YYYY

Passport Expiration Date (for mission trip insruance) *

MM

DD

YYYY