PARISH INFORMATION Parish Name * Pastor's Name Education and Training List degrees, areas of study, and any specialized training. Have you been on a mission trip before? * Yes No Please provide more information about the mission trip(s) such as location, type of ministry, and your involvement. CONFIDENTIAL INFORMATION Have you ever had problems with governments or the police at home or abroad? * No Yes Please provide more information Do you have a valid passport? (Passports are required for all missions.) * Yes No Passport Country of Issuance Passport Number HEALTH INFORMATION Do you have medical insurance that covers all medical or evacuation expenses in the country you are traveling to? * Yes No Health Insurance Company Policy Number List any health conditions we need to be aware of. List any allergies to food, medications, etc. Are you currently taking prescription medication? No Yes Please list medication and dosage. List any physical limitations we should be aware of. CONSENT & WAIVER Consent for Medical Treatment *
I authorize Renewal Ministries, through its employees, adult volunteers or agents to render or obtain such emergency medical care as may be necessary and make medical decisions on my behalf in the event that I am unable to make such decision for myself.
I agree to fully pay for any and all costs of medical or dental care provided to me and consented to by Renewal Ministries or its adult employees and volunteer leaders. Medical insurance information is attached.
I authorize the release of any medical or insurance related information necessary for my care. In the event it becomes necessary for Renewal Ministries or its adult employees or volunteer leaders to give consent for me, I agree to hold Renewal Ministries and/or its adult employees or volunteer leaders free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.
THIS AUTHORIZATION SHALL REMAIN EFFECTIVE UNTIL REVOKED IN WRITING AND DELIVERED TO RENEWAL MINISTRIES.
Waiver of Liability and Assumption of Risk and Indemnity Agreement *
In consideration of being permitted to participate in a Renewal Ministries International Mission Trip (hereafter known as the Mission Trip), I agree to what follows:
I acknowledge that participation in the Mission Trip carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid harm. I acknowledge that there are risks to my health (including death), safety and property and that I have read all appropriate State Department warnings regarding travel to the area. By signing this legally binding contract, I hereby assume the risks involved in the Mission Trip, including, but not limited to: loss of property, harm to my physical, mental and emotional wellbeing (including death) arising from accidents, illness, unsanitary conditions and criminal acts. I voluntarily and expressly agree to assume all risks and full responsibility for any illness, injury, death or property damages arising out of or related to this Mission Trip.
To the fullest extent permissible by law, I hereby release, waive, discharge and covenant not to sue Renewal Ministries, its Board of Directors, officers, employees, volunteer leaders and agents (hereafter known as Renewal Ministries) from liability from any and all claims including the negligence of Renewal Ministries resulting in personal injury, accidents or illnesses (including death) and property loss arising from, but not limited to participation in this Mission Trip.
To the fullest extent permissible by law, I herby agree to INDEMNIFY AND HOLD HARMLESS Renewal Ministries from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorneyâ€™s fees caused or alleged to have been caused by Renewal Ministries or otherwise as a result of my involvement in the Mission Trip and to reimburse Renewal Ministries for any such expenses incurred.
I agree that the laws of the State of Michigan only will govern every aspect of this Agreement and I further expressly agree that the foregoing waiver and assumption of risk and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of Michigan and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I acknowledge that I have read this waiver of liability, assumption of risk and indemnity agreement, fully understand its terms and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.