Puerto Rico Missions Trip Application. Puerto Rico Partnership: Led by Dr. Rafael Maldonado Jr. (Ray) P. O. Box 7079, Lakeland, Fl
|
|
- Howard Malone
- 6 years ago
- Views:
Transcription
1 Puerto Rico Missions Trip Application Puerto Rico Partnership: Led by Dr. Rafael Maldonado Jr. (Ray) P. O. Box 7079, Lakeland, Fl Mission trip dates: February 27 thru March 6, 2018 This application and initial payment must be filled out completely and submitted to Ray Maldonado by November 1, 2017 in order to be considered for participation in the trip. NAME: ADDRESS: male/female (circle one) DOB: TELEPHONE: Please describe briefly how you came to Christ and any significant growth seasons in your Christian life: (Use separate sheets as desired) Describe your personal devotional life: Are you a member of the Vineyard Church? participation in the church? If yes, how long and what has been your Please share the reasons you believe God is calling you to be involved with this trip. Describe any past mission s experience you have: In what ways has God used you in peoples lives? Have you led anyone to trust Jesus Christ as Savior? Describe any fears you have that might surface on a cross cultural mission trip:
2 Share your spiritual gifts and how you could be an asset on the short-term team (Socially, spiritually, skills and talents): Please evaluate yourself according to the following criteria: Quality Weak Strong 1 Serving Social Sensitivity Energy Level Teachable Flexible Healthy Communication Skills Adventuresome Response to Authority Coping Skills Dependable Describe any health concerns that the team leaders should be aware of. Please include comments which also include: personal sleep requirements, ability to handle fatigue, need for personal space and solitude, allergies, ongoing medical concerns, current medications, heat and sun sensitivity, food sensitivities, areas of physical or emotional limitation: Two character references: Name: Context in which they know you: Address: Telephone: Name: Context in which they know you: Address: Telephone: Share anything else you would like us to know about you, e.g. ever been to Puerto Rico?
3 The cost for the trip will be $1, It may be raised slightly, depending on airfare costs. The trip will include airfare, housing, meals, and transportation in Puerto Rico. The dates for payment are as follows: November 1, 2017 $375* This is a non-refundable amount. We will purchase your airline ticket right away. If you cannot attend, for any reason, you will have your airline ticket to use for a year. December 15, 2017 $400 February 1, 2017 $400 Total $1,175 Please make checks or money orders to: Iglesia La Viña In memo sec. please write:missions trip February 27-March 6, 2018 Send application and payments to: Dr. Rafael Maldonado Jr. P.O. Box 7079, Lakeland, Fl The trip will be led by Dr. Rafael Maldonado Jr. (Ray) Tentative ministry team meetings are Sundays 6:00 PM thru Zoom teleconferencing through a computer equipped with a camera. Please allow for a two hour meeting period. These meetings are mandatory for team members. November 5, 2017 December 3, 2017 January 7, 2018 February 11, 2017
4 Puerto Rico Partnership Missions Short-Term Missions Trip Liability Release Agreement I, (participant) acknowledge that I desire to participate in the following Puerto Rico Partnership Missions trip (hereinafter the Activity ): Aguadilla, Mayaguez and San Juan, Puerto Rico (trip locations) to be conducted approximately on or between: February 27 thru March 6, The Puerto Rico Partnership and the undersigned agree that my participation in the Activity poses risks including but not necessarily limited to: sickness and/or health hazards due to poor food and water, diseases, pests, and poor sanitation, personal injury, death, crime, political instability, government opposition to the Activity, and inadequate medical facilities as well as similar and dissimilar risks (herein Risks ). My participation in any and all activities is voluntary and I agree to accept the risks of my participation, including all risk of personal injury or death. In consideration of the Puerto Rico Partnership permitting me to participate in the Activity and all its related activities and to use La Viña and Vineyard facilities and equipment, on behalf of myself and my personal representatives and their successors in interest (all hereinafter referred to as releasers ), I do hereby release the Puerto Rico Partnership and La Viña de Mayaguez, its officers, directors, employees, representatives and agents (hereinafter referred to as releases ) from any and all liability for any loss, cost, expense or damage and any claim for damages thereafter, on account of injury to my person or property or death, whether caused by the negligence or releases or otherwise, while I am participating in any way in or preparing for the Activity. I further agree to indemnify, defend and hold harmless releases and each of them from all loss, liability, damage, expense or cost which any of the releases may suffer or incur due to or in any way arising out of my participation therein and related activities, whether caused by the active or passive negligence of any of the releases or otherwise. Medical insurance [please check box(s) below that apply]: I understand I DO have the following medical and/or accident insurance policy(s) and I agree that I am responsible to submit and process any claims for coverage and/or reimbursement subject to the insurance company s policies and to pay any and all medical and/or dental expenses directly or indirectly related to my participation in the Activity which are not covered under the policy terms. I understand that the Puerto Rico Partnership has no responsibility for premiums, coverage or claims there under. Name of company Policy No. I DO NOT have medical or accident insurance, and I agree to pay any and all medical and/or dental expenses directly or indirectly related to my participation in the Activity, including during the transportation to and from the Activity. I understand that the Puerto Rico Partnership has no responsibility for any medical and/or dental expenses I may incur. Short Term Missions Liability Agreement 1 of 2 total pages Ver /
5 I do hereby authorize the Puerto Rico Partnership or its representative(s), team leader(s), team member(s), supervisor(s) and vehicle driver(s), in case of medical emergency, to give consent to a physician and/or hospital for emergency medical, surgical or dental examination and/or treatment while on this trip. FOR MINORS ONLY: Parental Consent for medical treatment of a minor participant I, (print name) the parent/legal guardian of the participant, who is a minor, I do hereby authorize the Puerto Rico Partnership or its representative(s), team leader(s), team member(s), supervisor(s) and vehicle driver(s), in case of medical emergency, to give consent to a physician and/or hospital for emergency medical, surgical or dental examination and/or treatment while on this trip. If there is an emergency please use best efforts to contact me at: (Phone). If there is an emergency and I cannot be reached please contact: Name: Relationship: Address: Phone: City: State: WHO IS AUTHORIZED IN MY BEHALF Zip: Signature of Guardian/Parent I agree that in the event my conduct is considered by the Puerto Rico Partnership or its representatives to be so unsatisfactory that it jeopardizes the safety and/or success of the Activity, and that mediation during the Activity has failed to correct my conduct, that my services in connection with this Activity shall end and I may be required to return home before completion of the Activity, possibly at my own expense. I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Georgia and Puerto Rico and that, if any portion of the agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Any portion of this agreement that is held invalid for any reason shall be enforced to the fullest extent permitted by applicable law I have carefully read the above release and I know its contents. I am aware that this is a release of liability and I sign this voluntarily. To the extent that I am a minor, my parent or legal guardian s signature below indicates that my parent or legal guardian hereby expressly gives to the Puerto Rico Partnership and the other releasers the same releases, consents and indemnities set forth herein. I hereby release the Puerto Rico Partnership and its representatives (including all releases as defined above) from any claim whatsoever on account of first aid, treatment or service rendered to me during participation in the Activity. This release contains the entire agreement between the parties relating to the subject matter. The terms of this release are contractual and not a mere recital. READ BEFORE SIGNING Print Name of Participant Signature of Participant Date SIGNATURE OF PARENT OR GUARDIAN (IF PARTICIPANT IS A MINOR) CONSENTING TO A MINOR S PARTICIPATION UNDER THE FOREGOING TERMS AND CONDITIONS: Print Name of Guardian/Parent Signature of Guardian/Parent Date Short Term Missions Liability Agreement 2 of 2 total pages Ver /
Marketplace Missions
Marketplace Missions PMB 114, PO BOX 9011, Calexico,, CA 92232-9011 9011 9011, Telephone:(916) 996-0964 Fax:(916)313-3478 Volunteer Application (please print or type) Instructions Filling out this application:
More informationSHORT-TERM MISSIONS APPLICATION
GENERAL INFORMATION Date Last Name First Name Middle Name Please print your name clearly EXACTLY AS IT APPEARS ON YOUR PASSPORT Present address: City State Zip DOB / / Age Gender: M F Grade Email Home
More informationThese forms are for reference only and will be sent to you to sign electronically. TEAM AGREEMENT
These forms are for reference only and will be sent to you to sign electronically. TEAM AGREEMENT Our vision for global(x) trips is that they will be opportunities for people to pursue spiritual growth
More informationMissional Living Mission Trip - Missionary Participant Information STUDENT INFORMATION (If you are 17 yrs. Old and under)
Missional Living Mission Trip - Missionary Participant Information STUDENT INFORMATION (If you are 17 yrs. Old and under) This information form is to designed to fulfill several purposes: it will help
More informationAmerican Baptist Churches of Pennsylvania and Delaware January 30 - February 6, 2019 (Wednesday Wednesday) Haiti Mission Trip
American Baptist Churches of Pennsylvania and Delaware January 30 - February 6, 2019 (Wednesday Wednesday) Haiti Mission Trip Part 1: Mission Trip Application: The total Cost is $1,175 $400 Deposit Due
More information2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA
2015 Mission Team Waiver / Release Agreement Orangecrest Community Church 5005 La Mart Dr., Suite #202, Riverside CA 92507 951-686-0152 Name of Participant : 2015 Mission Trip to (Location and Approximate
More informationINFORMED LETTER OF CONSENT for EASM S MIDDLE SCHOOL RETREAT 02/23/ /24/2018
INFORMED LETTER OF CONSENT for EASM S MIDDLE SCHOOL RETREAT 02/23/2018 02/24/2018 Details of the activity: The Middle School retreat is an overnight event sponsored by Edgewater Alliance Church. Students
More informationFellowship Baptist Church Youth Ministry Permission Forms
Fellowship Baptist Church Youth Ministry Permission Forms Fellowship Baptist Church, Youth Ministry, and Volunteers Are Designated By The Abbreviation FBC Throughout This Entire Form GENERAL PERMISSION
More informationMath + Leadership Camp Rancho Minerva Middle School July 11-22, Registration Form
Math + Leadership Camp 2016 @ Rancho Minerva Middle School July 11-22, 2016 Registration Form CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 OFFICE
More informationBMDMI Mission Service Application
BMDMI Mission Service Application NAME EXACTLY AS IT APPEARS ON PASSPORT Name I go by Maiden Name T-shirt Size: Passport # Issuing Country Passport Expires: / / Address City State Zip Phones: Home Work
More informationVolunteer Staff Application
Special Journeys, LLC P.O. Box 583, Boys Town, NE 68010 (402) 884-1014 lexi@specialjourneys.org Volunteer Staff Application Name Address DOB (necessary for travel docs) Do you have a valid US Passport:
More informationIvy Tech Community College
Ivy Tech Community College POLICY TITLE International Travel for Faculty/Staff POLICY NUMBER ASOM 7.15 PRIMARY RESPONSIBILITY Academic Affairs CREATION/REVISION/EFFECTIVE DATES Created July 2013/Effective
More informationWRAP/YMCA Expanded Learning Program
2018-2019 School Year School: Child s Last Name: First Name: Sex: M F Birth date: / / Age: Home Phone: ( ) Home Address: Cell Phone: ( ) City: State: Zip: Child lives with: Mom Dad Both Parents Other Begin
More informationFACULTY-LED STUDY ABROAD PROGRAM APPLICATION
FACULTY-LED STUDY ABROAD PROGRAM APPLICATION Country of Study: Dates of Travel: I. PARTICIPANT INFORMATION Name: Street Address: City: State: Zip Code: Date of Birth: Passport #: Country of Citizenship:
More informationATHENS YMCA CAMP KELLEY SUMMER CAMP 2018
ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration
More informationAPPLICATION FOR PART TIME EMPLOYMENT
APPLICATION FOR PART TIME EMPLOYMENT Position: Desired Hourly Rate: Last Name First Name Date Address Street City State Zip Code Phone Number Email Address Are you at least 18 years of age or older? Yes
More informationVapor Ministries Trip Application Form
Vapor Ministries Trip Application Form Name/date of Vapor trip you are applying for Applicant Information Legal Name (as it appears on passport) Name you prefer to be called Date of birth Gender (please
More informationApply for a passport immediately!
Dear K2K Mission Team Applicant, Bwana Asifiwe! Thank you for thinking about joining us for the K2K Mission trip in June of 2016. We are very excited to be taking a Community Team, a Medical Team and a
More informationRegistration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:
Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,
More informationVolunteer Information Form & Health History Packet
Volunteer Information Form & Health History Packet General Information Name: Age (If under 21): Address: City: State: Zip: Date of Birth: / / Home Phone# Cell Phone # Email: Occupation: Employer/School
More informationJESUS IN HAITI MINISTRIES Mission Trip Application and Personal Agreement (PAGE 1 OF 3)
RETURN AS SOON AS POSSIBLE TO: JiHM Trips, c/o Lifepointe Church, 1616 West St, Woodland, CA 95695 Group Leaders: Please gather ALL pages for every participant and mail in one envelope to above address
More informationRELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: CSU, Chico Recreational Sports Youth Camps Activity Date(s) and Time(s): Summer 2018 (June 11 August 10,
More informationREQUEST FOR AUTHORIZATION STUDENT TRAVEL: UNIVERSITY ORGANIZED OR SPONSORED EVENTS THE UNIVERSITY OF TEXAS AT AUSTIN. Requestor/Sponsor Information
Part I. Requestor/Sponsor Information Name of University Employee Responsible for Trip: Position /Title: Administrative Unit/Organization: Phones: Office Cell Email Part II. Trip Information Purpose of
More information2018 CYC Junior Rowing Summer Program Registration
2018 CYC Junior Rowing Summer Program Registration Rower s Last Name First Name Age/DOB Address City State Zip Code Email Cell School Grade Level (Fall 2018) Parent s Last Name First Name Address City
More informationColorado Trek Paper Work Check List
Colorado Trek Paper Work Check List Please make sure you have all your paperwork before sending it in Due June 2 - Paperwork Due June 2 - Full payment of $2400 NAME HATS Release Form Adventure Experience
More informationRelease and Waiver of Liability. Release and Waiver of Liability for Adults Page 2 & 3. Release and Waiver of Liability for Minor Page 4 & 5
Release and Waiver of Liability Release and Waiver of Liability for Adults Page 2 & 3 Release and Waiver of Liability for Minor Page 4 & 5 1 Release and Waiver of Liability for Adults Adult - An adult
More informationVisions Global Empowerment and Nazareth College Ethiopia Service-Learning Trip (December 2018 January 2019) VOLUNTEER APPLICATION FORM
Visions Global Empowerment and Nazareth College Ethiopia Service-Learning Trip (December 2018 January 2019) VOLUNTEER APPLICATION FORM ALL VOLUNTEERS Permanent Address Information: NAME: STREET: CITY:
More informationSUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM
SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM Personal Information Child s Name Age of Birth Parent/Legal Guardian 1 Phone Parent/Legal Guardian 2 Phone Address Alternate Phone work cell other
More informationStudy Abroad Participant Agreement Assumption of Risk, Waiver of Liability and Indemnification
Standard Form Approved by the Lone Star College System Office of General Counsel Study Abroad Participant Agreement Assumption of Risk, Waiver of Liability and Indemnification I, (name of student) have
More information2017/18 Out of School Program Registration Form
2017/18 Out of School Program Registration Form Child: First Name MI Last Name YMCA Member Non Member E-mail NOTE: There is a one time, non-refundable $20 registration fee per child required to secure
More informationAthletics Participation and Pre-Participation Head Injury/Concussion Reporting Form
Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of
More informationTractor Safety Certification
Tractor Safety Certification June 16-18, 2014 Monday - Wednesday 8:00 am 3:00 pm Amity High School 503 Oak Street Amity, Oregon 97101 What: Tractor Safety Training and Certification Course, sponsored by
More informationJr. High, Senior High & College age Youth Ministry
A Ministry of Yosemite Lakes Church 43840 Patrick Avenue. Coarsegold, CA 93614 559-658-7447 Jr. High, Senior High & College age Youth Ministry The Great Commission 18 Then Jesus came to them and said,
More informationThe Roman Catholic Diocese of Charlotte Office of Vocations
The Roman Catholic Diocese of Charlotte Office of Vocations Thank you for your interest in Quo Vadis Days 2017 at Belmont Abbey College. I look forward to our time together. Quo Vadis Days is an opportunity
More informationKaren McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant:
Volunteer- Counselor in Training Applications Spring 2018 Dear Counselor in Training Applicant: Boardman Park Adventure Day Camp Program prides itself on its reputation for quality and service. This recognition
More informationRegistration for Information Technology Summer Camp for rising 7 th, 8 th, and 9 th grade girls
Registration for Information Technology Summer Camp for rising 7 th, 8 th, and 9 th grade girls Student Name: Date of Birth: If you are a returning camper, indicate what year you attended: School Name:
More informationTractor Safety Certification
Tractor Safety Certification June 15, 16, 17, 2015 Monday - Wednesday 8:00 am 3:00 pm Amity High School 503 Oak Street Amity, Oregon 97101 What: Tractor Safety Training and Certification Course, sponsored
More informationCalvary Chapel Chattanooga Missions Ministry Team Member Application
Calvary Chapel Chattanooga 2016 Missions Ministry Team Member Application Application Instructions: To be considered for an upcoming short-term trip, you must: 1. Complete the following application. 2.
More informationSt. Augustine Amphitheatre Farmer s Market. Vendor Application Instructions
St. Augustine Amphitheatre Farmer s Market Vendor Application Instructions To be considered for participation in the St. Augustine Amphitheatre Farmer s Market, please submit: - Completed and signed Vendor
More informationNSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.
PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release
More informationRELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK & WAIVER
RELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK & WAIVER READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECT IS TO RELEASE 7 HILLS CHURCH/CENTRAL YOUTH CONFERENCE, ITS EMPLOYEES, OFFICERS, DIRECTORS,
More informationINTERNSHIP APPLICATION
INTERNSHIP APPLICATION Personal / Academic Information: ID # Class Name First MI Last Major(s) CQPA MQPA E-mail Campus Box# Phone # Department of Internship Internship Title Start Date End Date Total Number
More informationINTERNATIONAL TRAVEL PROGRAM
1973 Edison Drive Piqua, OH 45356 INTERNATIONAL TRAVEL PROGRAM Acceptance, Release, Assumption of Risk and Waiver of Liability I, the undersigned ( Participant ), have been approved to participate in a
More informationSummer Camp Application INTERNATIONAL DEVELOPMENT 101
INTERNATIONAL DEVELOPMENT 101 Student Information Student Name: Sex : Male / Female Student Preferred/Nickname: Mailing Address: Home Phone Number: Cell Phone Number: School: Grade (Entering): Date of
More informationBefore and After School Care
Before and After School Care BLAIR FAMILY YMCA 2016-2017 School Year Registration Forms To put Christian principles into practice through programs that build a health spirit, mind and body for all. -YMCA
More informationPlease print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall.
2018 Conservation Ecology in Ecuador/ Galapagos Islands Deposit Form Please print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall. Upon receipt of your deposit
More informationRaising Money for Autism
Raising Money for Autism Appendix I 1.) Release of Liability Form: 2.) Consent and Release of Guardian Form: 3.) Volunteer Sign Up Sheet 4.) Bowl-a-Thon Flyer In this section you will find all the forms
More informationAMBASSADORS IN MISSION
PARENTAL CONSENT AND AUTHORIZATION For Minors under the Age of 18 Foreign Travel aim@ag.org (417)862-2781 ext. 4029 The General Council of the Assemblies of God 1445 N. Boonville Ave. Springfield, MO 65802
More informationINSURANCE INFORMATION
These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we
More informationGuatemala Trip Travel Forms
Guatemala Trip Travel Forms To Grow in Faith and Carry On the Works of Jesus Christ Multi-generational trip to Guatemala An opportunity for men, women, and families to travel, learn, and serve together.
More informationGEORGIA STATE UNIVERSITY
PARTICIPATION AGREEMENT AND WAIVER Assumption of Risk: I am the parent or legal guardian of the Participant, and allow participation in a Georgia State University Program (the Program ), facilitated by
More informationRe-Enrollment Packet st - 6 th. Applicant s Name Grade
Applicant s Name Grade Aftercare needed: Yes or No Re-Enrollment Packet 2019-2020 1 st - 6 th Thank you for considering Mountain Home Christian Academy in the educational future of your child. Our program
More informationTRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL
TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL Program Name: Destination: Name(s) of LSC Employee Traveling with Group: LSC Employee(s) phone contact: - - or - - Budget
More information2016 5K Reindeer Run/Walk Team Registration
2016 5K Reindeer Run/Walk Team Registration Team Registration Forms and Waiver must be fully completed and received by December 2 nd in order to receive the $20/person group rate; Minimum of 3 people per
More informationStudent Travel Packet The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four weeks prior to making
More informationField Trip Forms and Procedures
EAST SIDE UNION HIGH SCHOOL DISTRICT Instructional Services Division Julianna Arreola Administrative Secretary Phone: 347-5061 FAX: 347-5065 Email: arreolaj@esuhsd.org Field Trip Forms and Procedures Student
More informationCamp Tatanka Summer Camp Registration Form
WTAMU and the City of Canyon Child s First Name Camp Tatanka Summer Camp Registration Form Camper & Parent s Information Last Name Grade Fall 2018: Age (on 1 st day of camp): Birth Date: / / M / F Child
More informationYoga Retreat Terms and Conditions
SUNDARA DESTINATIONS, LLC Yoga Retreat Terms and Conditions Sundara Destinations, LLC ( Sundara ) is committed to providing the highest quality yoga experience for all of our guests. To help make that
More informationPARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE
More informationName - Mailing Address - Address - Occupation - Home Phone - Work Phone - Date of Birth - \ \ Name - Home Phone - Work Phone -
Please take time to carefully fill out this form as it will help us to plan your trip to your satisfaction. Name - Mailing Address - Email Address - Occupation - Home Phone - Work Phone - Date of Birth
More information2016 OUCI Chinese Bridge Summer Camp Application
STUDENT INFORMATION Name (as it appears on your passport) Passport # Passport Expiration Date DOB Gender Cell Phone Email Address City State Zip PARENT/GUARDIAN INFORMATION Parent Phone Email Parent Phone
More informationTITAN SOFTBALL CAMPS Registration Form
Registration Form CAMP DATE: CAMPER S NAME: CONTACT INFORMATION ADDRESS: CONTACT EMAIL: CONTACT PHONE: PLAYER INFORMATION AGE: GRAD YEAR (HS): PRIMARY POSITION (circle ONE choice): P C 1B 2B 3B SS OF UTL
More informationStudent Domestic Travel Instructions
Student Domestic Travel Instructions This information is provided to assist University Faculty and Staff members in planning and conducting classroom and/or co-curricular trips. Page 1. This page provides
More informationPlease indicate the following:
Please indicate the following: Male Church & Denomination (if applicable): Female General Information Surname: Please list your name as it appears on your passport. If you do not yet have your passport,
More informationNew Patient Intake Paperwork
New Patient Intake Paperwork NAME: Last First Middle DATE OF BIRTH: SEX: M / F ADDRESS: Street City State Zip PHONE: MOBILE: EMAIL ADDRESS: EMPLOYER NAME: PHONE: EMPLOYER ADDRESS: EMERGENCY CONTACT: PHONE:
More informationElite Athlete Strength and Conditioning Camp
Elite Athlete Strength and Conditioning Camp For your child s safety, and in order to be permitted to participate in all activities, please fill out this form and return it to St. Michael s Summer Camps
More informationOVERSEAS PROGRAMS STUDENT AGREEMENT
OVERSEAS PROGRAMS STUDENT AGREEMENT I, (print or type name of Student), acknowledge that I have voluntarily applied to an overseas study program ( Program ) offered by the Santa Monica Community College
More informationCOUCH TO 5K RUN. A FOCUS 4 WOMEN CRC FALL 2017 Saturday, November 4, 2017, 9:00 a.m. to 4:00 p.m. Space is limited, so sign up soon!
COUCH TO 5K RUN A FOCUS 4 WOMEN CRC FALL 2017 Saturday, November 4, 2017, 9:00 a.m. to 4:00 p.m. Space is limited, so sign up soon! Applications will be available starting Tuesday, August 1, 2017, in the
More informationSchedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete
When: Saturday, December 9. 2017 Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete Instructors: SU Coaches & current SU Athletes Schedule: 9:00-9:45 Registration 9:45
More informationCamp Medical Information & Release Form
Global Youth Ministry Global Youth Camps 40 Blackhawk Trail Chatsworth, GA 30705 877-251-1800 www.globalyouthministry.org Camp Medical Information & Release Form Name Gender Age Birthdate / / Church/Org
More informationMAILING ADDRESS AREA CODE + PHONE NUMBER ZIP
Kentucky District Pathfinder s Mission Trip Application Packet Life Bridge Inner City Missions Savannah, Georgia June 1 June 7, 2009 Mission Trip Fee $400.00 per person LAST NAME FIRST NAME DATE OF BIRTH
More informationPaleontology Field Program - Registration
Morrison Natural History Museum 501 CO-8 / PO Box 564 Morrison, CO 80465 Paleontology Field Program - Registration (one per party) Dig Name: Date: Name: Party Of: Mailing Address: City, State & Zip Code:
More informationPLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS!
109 Harrison St. NE, Leesburg, VA 20176 Phone: 703.737.6772 Fax: 703.737.6788 www.loudounhabitat.org RELEASE AND WAIVER OF LIABILITY FOR MINORS PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS
More information526 Edelweiss Village Parkway Gaylord, MI Office: (989) Fax: (989)
Dear Volunteer: Welcome to the Otsego County Habitat for Humanity Family! We hope you will find volunteering with us rewarding as you join us in our mission as a nondenominational Christian housing ministry,
More informationVOLUNTARY SHORT TERM MISSION SERVICE Participant Application. Name: Last First Middle Address: City: State: Zip:
VOLUNTARY SHORT TERM MISSION SERVICE Participant Application Name: Last First Middle Address: City: State: Zip: Home Phone: Cell: DOB: Work: Email: Age: Citizenship: T-Shirt Size: Social Security #: D.L.
More information(If you are a messenger, your pastor must sign the messenger form, if there is no Pastor s signature, you cannot vote at the business meeting.
Southern Baptist Conference of the Deaf At Ridgecrest Conference Center, NC Registration Form July 15-19, 2019 Important: one form for each person (even if same family) Full Name: Age: Gender: M or F Marital
More informationSCCA Rally/Solo Release and Waiver Guidelines
RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA
More informationStudent Travel Packet The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four weeks prior to making
More information815 West Joppa Road Towson, MD Phone: STAFF APPLICATION. Name: Permanent Address:
Water Safety Consulting & Pool Management, LLC 815 West Joppa Road Towson, MD 21204 Phone: 410-213-5151 Email: watersafetyconsulting@yahoo.com STAFF APPLICATION Name: Permanent Address: City: State: Zip:
More informationUniversity of Portland. International Travel Acknowledgement of Responsibility, Express Assumption of Risk, and Release of Liability
University of Portland International Travel Acknowledgement of Responsibility, Express Assumption of Risk, and Release of Liability TRIP TITLE AND DATE For the benefit of the University of Portland (the
More informationJESUS IN HAITI MINISTRIES Mission Trip Application and Personal Agreement (PAGE 1 OF 3)
RETURN 4 MONTHS BEFORE YOUR TRIP DATE Jesus in Haiti MINISTRIES Group Leaders: Please gather ALL pages for every participant and mail in one envelope to: Elizabeth Juhler, c/o Lifepointe Church, 1616 West
More informationSTUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT
STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT I,, desire to participate voluntarily in the Study Abroad Program, West Texas A&M University, described
More informationPARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:
Spring Break Camp PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Have you attended Camp C-Woo before? Yes No CWU ID Number Spring
More informationCHARLEY'S ANGELS TEAM FLORIDA VOLUNTEER CHAPLAIN APPLICATION (Must be 18 Years or Older) Full (Legal) Name
CHARLEY'S ANGELS TEAM FLORIDA VOLUNTEER CHAPLAIN APPLICATION (Must be 18 Years or Older) Full (Legal) City State Zip Code Phone (work) (home) (cell) E-Mail Marital Status: Married Single Divorced Separated
More informationFor office use only: Agency Participant. T-shirt received Shirt size: Adult- M L XL
SUMME ER DAY CAMP WEINGART-LAKEWOOD FAMILY YMCA REG GISTRA ATION PACKE ET For office use only: Agency Participant Year Round Participant T-shirt received Shirt size: Youth- XS S M L Adult- S M L XL SUMMER
More informationPole Vault Camp Oct. 14, 21, 28; Nov. 4, 11 Grades 9-12
TRACK & FIELD Patrick Georgia October-November Pole Vault Camp Oct. 14, 21, 28; Nov. 4, 11 Grades 9-12 The Spring Season Is Fast Approaching To help you get a jump on the competition, St. Norbert is pleased
More informationKeowee Sailing Club Sailing Camp Application
Keowee Sailing Club Sailing Camp Application I/we hereby apply for the below named camper to participate in the Sailing Camp to be held at Keowee Sailing Club, Seneca, SC, June, 2017. Campers should arrive
More informationANTEATER RECREATION SUMMER CAMP
ANTEATER RECREATION SUMMER CAMP COMPLETING YOUR WAIVER FORMS All forms have the ability to be completed through Adobe Acrobat. At this time, the University still requires inked (not electronic) signatures.
More informationVolunteer Application
Partners for Rural Health in the Dominican Republic www.prhdr.org Date Volunteer Application Please make sure to complete all information. If the applicant is under the age of 18, this form must be filled
More informationPersonal Medical Record
Personal Medical Record Personal details Age: Height (in meters): Weight (in kgs): BMI (kgs/metres 2 ): *Online BMI calculation tools are easily available 1. Any previous illness - past 3 months (mention
More informationTraveler and Emergency Contact Information
The University's procedures for travel require considerable advance planning. Student organizations wishing to travel must complete the attached Student Travel Forms at least four (4) weeks prior to making
More informationSummer Intersession 2018 Faculty-Led Travel Program Buenos Aires, Argentina Travel Dates: July 15th August 7th, 2018
Part A: Application Checklist, Agreement, and Release Form Please submit the following materials in support of this application: 1. This Completed and Signed Application Checklist, Agreement, and Release
More informationYOUTH APPLICATION (17 & under accompanied by a parent or guardian)
MINISTRY YOUTH APPLICATION (17 & under accompanied by a parent or guardian) DATES Attach PHOTO Here Use paper clip OR Email a photo to office@im-canada.ca and check this box Please do not staple photo
More informationOregon 4-H Member Enrollment Form
Oregon 4-H Member Enrollment Form County 4-H Club (s) Family Information: New Enrollment.. Re-enrollment. Youth Leader.. Family Last Name Family E-mail Family Primary Phone Family Mailing Address Street/Mailing
More informationYMCA of the Coastal Bend Summer Camp 2018 Enrollment Form
PARTICIPANT INFORMATION: YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form Child (1) Name: Sex: [M] [F] (circle one) of birth: / / Camp Type/Location: YMCA Day Camp (Pre-K - 5 th ) Downtown YMCA
More informationOld Hickory Wrestling Club
Old Hickory Wrestling Club Jackson Township was named after Andrew Jackson in 1815 following his victory at the Battle of New Orleans. Heavily outgunned and outnumbered, Jackson and his soldiers managed
More informationAll Documents in this Packet MUST BE COMPLETED and Returned to the Group Leader along with your Trip Deposit in order to Reserve your Space.
DOCUMENT CHECK-LIST All Documents in this Packet MUST BE COMPLETED and Returned to the Group Leader along with your Trip Deposit in order to Reserve your Space. Please ask for a Copy of these Documents
More information(847)
2017 Player/ Parent Tryout Information Sheet Thank you for attending Pi Volleyball spring club tryouts. Tryouts will conclude Monday, March 13th; within 1-48 hours of the tryouts conclusion, I will send
More informationSubsidized after school slots requires participant to attend the after school program 5 days/week and stay until 5:30PM
Sunnyside Elementary After School Program Registration 2016-2017 School Year SECTION A: PROGRAM SITE AND SCHEDULE School: Sunnyside Elementary After School Program Monday Tuesday Wednesday Thursday Friday
More informationTULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /
Physical Examination Information Date / / Name of Camp: Name of Participant: Age: Birth date: / / Each participant must EITHER attach a copy of a physician conducted sports examination applicable to this
More information