Trip Application, part 3

Liability Release

Friends Forever Ministry Trip
CLICK for Trip Application Pastor's Reference  Honor Code and Trip Payments and other information

 

 

Existing medical limitations, including allergies, which would affect or limit participants activity on the Missions trip(s) of which medical personnel should be made aware, please indicate below.  Without such notice, it is assumed that the participant is physically fit and mentally capable of participation in all activities.  Any medical conditions and/or special instructions are:

 

 

 

 

Mark Muirhead Ministries, Inc. aka Friends Forever Missionary Fellowship  and the name of your sponsoring church or organization ___________________________________________________

including employees and representatives of the aforementioned organizations shall be held harmless from any suit, action, damages or claim at law or otherwise, resulting from or arising out of any illness, injury, accident, death which my befall (name of participant)________________________________and/or his/her property while part of the Mark Muirhead Ministries, Inc., www.ilovejamaica.org dba Friends Forever Missionary Fellowship trip(s). If the participant is a minor this covenant is applicable to the participant and his/her parents or guardian.

 

Participants must give home and stateside emergency contact information to sponsoring church or organization leader on the trip (give to your group leader - medical insurance information, including phone and identification numbers). It is the responsibility of the group leader and/or student for any special mission trip medical coverage for the week of participation.

 

The undersigned parent or guardian hereby authorizes, sponsor, sponsorís agent or employee to take such action as may be necessary for the medical care or treatment including the administration of medication, performing of surgery, or such other action as needed in the event of injury or illness of a participant when parent or guardian cannot be reached for authorization. In the event the above authorized refuse or are not able to act, Mark Muirhead Ministries, Inc., aka www.ilovejamaica.org dba Friends Forever Missionary Fellowship are authorized as set forth above.  This authorization may be presented to medical personnel without liability or said personnel to seek further authority.

 

 

X ________________________________________/ _____________

(Signature of participant)                                             (Date)
X/ Notary Seal and Date is required (no copy, must be orginal).

 

X________________________________________/ ______________

(Signature of parent or guardian if participant is under 18)  (Date)

X/ Notary Seal and Date is required (no copy, must be orginal).