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2020 Mission Trip Registration
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* Indicates required question
Email
*
Your email
Mission Trip Destination
*
Omaha, July 25-August 1, 2020
PARTICIPANT INFORMATION
First Name
*
Your answer
Last Name
*
Your answer
Cell Phone
*
Your answer
Home Phone
*
Your answer
Gender
*
Male
Female
Church you are attending
*
Your answer
Are you a church member
*
Yes
No
Date of birth
*
MM
/
DD
/
YYYY
T shirt size
*
Youth:Small
Youth:Medium
Youth:Large
Adult:Small
Adult:Medium
Adult:Large
Adult:X Large
Adult:XX Large
Adult:XXX Large
Adult: XXXX Large
IMPORTANT
Are you willing to be flexible and adaptable?
*
Yes
No
Required
RELEASES FOR IMAGES:
*
TCBA may take photographs or make audio/video recordings of the mission trip. In addition images may be used in advertising, promoting and publications for future TCBA mission trips.
Yes, I may be photographed.
No, I CANNOT be photographed.
IF A MINOR: PARENT INFORMATION
Parent/Guardian
*
Your answer
Relationship
*
Your answer
MEDICAL INFORMATION
Do you have health insurance?
Yes
No
Clear selection
Are you under a doctor's care at present?
Yes
No
Clear selection
Condition
Your answer
List any know allergies:
*
Your answer
List any physical disabilities that would keep you from participating in mission activities:
*
Your answer
In the event of an emergency call:
*
Name, relationship, phone number
Your answer
Permission to treat in an Emergency
*
Your selection gives permission for TCBA to seek emergency medical treatment if needed.
Yes
No
Submit
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