Application for Short Term Missions

We're so excited that you're considering joining this mission trip! This is a chance to step out in faith, serve others, and experience God’s work in a new way.

As part of preparing for the mission trip, we need everyone to complete a liability form. We know—paperwork isn’t the most exciting part of the trip, but it will help us get to the where we want to!

Name

*

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Age

*

Passport

Citizenship (Passport)

*

Full Name as Appears on Passort

*

Gender

*

Please select all that apply.

Male Female

Marital Status

*

Please select all that apply.

Single Engaged Married Separated Divorced Widowed

Emergency Contact

Name

*

Relationship to you

*

HOLD HARMLESS, WAIVER OF LIABILITY, AND EMERGENCY MEDICAL CARE AUTHORIZATION

Short Term Mission Destination:

*

1. I fully understand that I may be traveling to or staying in areas of the world that may have unstable political, economic, and security situations, where acts of war, terrorism, violence, or potential dangers due to a lack of control over the local population could occur at any time.

I have read and agree to the following / 읽고 동의합니다.

*

Please select one option.

Yes No

2. I fully understand that I may encounter difficult climates and living conditions and that risks are present concerning means of travel, food, water, diseases, pests, poor sanitation, and other health-related situations. Additionally, medical or emergency treatment may be inadequate or unavailable.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

3. I accept and assume full responsibility for my personal actions and any and all risks of property damage or personal injury that may occur during or as a result of my participation, including potential injury while working.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

4. With the above in mind, I fully understand and agree that PMBC and all of its entities, their staff members, successors, assigns, officers, agents, representatives, ministry divisions, mission trip leaders, volunteers, and other participants shall not be responsible or liable in any way for any accident, loss, death, injury, or damage to myself or my property in connection with the Trip or any portion of the Trip, even if said injury or action is due to the alleged negligence of PMBC or such other participants.

Further, I do hereby agree to indemnify and unconditionally hold PMBC and such other participants harmless against any and all liabilities, damages, claims, suits, judgments, and associated costs and expenses (including, without limitation, reasonable attorneys' fees) of any kind in connection with the Trip or any portion of the Trip.

I make this agreement on behalf of my heirs, agents, fiduciaries, successors, and assigns. I waive, knowingly and voluntarily, each and every claim or right of action I have now or may have in the future against the church or such other participants related to the Trip, even if any such claim or right of action is caused by PMBC's alleged negligence.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

5. I hereby state that I am in good health and have all medications necessary to treat any allergic or chronic conditions, and I am able to administer such medications without assistance. If at any time during the Trip I require emergency medical care and am unable to give consent due to my physical or mental condition, I authorize emergency medical care decisions to be made on my behalf. I specifically release PMBC, in making those emergency medical care decisions, from any and all liability associated with said decisions, even if injury or death results from PMBC alleged negligence.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

6. I have carefully read the foregoing and understand that my signature herein holds PMBC, its officers, employees, mission trip leaders, volunteers, and other agents or representatives harmless from any liability for injury, damage, loss, or accident as outlined herein, as well as for any loss or damage related to scheduling delays or interruptions.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

7. This document does not release PMBC or any other participants from liability for gross negligence.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

8. I have carefully read, fully agree to, and intend to be legally bound by all terms of this hold harmless agreement, waiver of liability, and emergency medical care authorization.

I have read and agree to the following / 읽고 동의합니다.

*

Please select all that apply.

Yes No

FULL NAME

*

ONLY IF MINOR: My guardian has agrees and give full permission for PMBC regarding the above.

*

Please select all that apply.

I am not a minor Yes No

TODAY'S DATE

*

Description

We're so excited that you're considering joining this mission trip! This is a chance to step out in faith, serve others, and experience God’s work in a new way.

As part of preparing for the mission trip, we need everyone to complete a liability form. We know—paperwork isn’t the most exciting part of the trip, but it will help us get to the where we want to!

Please Fix the Following

Close