2021 Mission Trip Registration
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Email *
Mission Trip Destination *
PARTICIPANT INFORMATION
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Cell Phone *
Home Phone *
Gender *
Church you are attending *
Are you a church member *
Date of birth *
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/
DD
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YYYY
T shirt size *
IMPORTANT
Are you willing to be flexible and adaptable? *
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.
IF A MINOR: PARENT INFORMATION
Parent/Guardian *
Relationship *
MEDICAL INFORMATION
Do you have health insurance?
Clear selection
Are you under a doctor's care at present?
Clear selection
Condition
List any known allergies: *
List any physical disabilities that would keep you from participating in mission activities: *
In the event of an emergency call: *
Name, relationship, phone number
Permission to treat in an Emergency *
Your selection gives permission for TCBA to seek emergency medical treatment if needed.  
Voluntary participation.                                                                                                                                                                                          I, acknowledge that I have voluntarily applied to participate in a short-term mission trip to Omaha, Nebraska on July 24-July 31, 2021 sponsored by Tri-County Southern Baptist Association (TCBA) TCBA is providing assistance in arranging the mission trip, which involves travel to, and volunteer work in the United States. Participants consent to being photographed and/or videotaped while on mission trips for promotional use by TCBA.                                                      Assumption of risk.                                                                                                                                                                  I am aware that the mission trip poses risks including but not limited to: sickness, crime, travel, transportation, as well as similar and dissimilar risks. I AM AWARE THAT THE MISSION TRIP MAY INVOLVE RISKS. I AM VOLUNTARILY PARTICIPATING IN THE MISSION TRIP WITH KNOWLEDGE OF THE RISKS INVOLVED. I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH THAT MAY RESULT FROM MY PARTICIPATION I THE MISSION TRIP.                                                                   Release from liability.                                                                                                                                                  As consideration for being permitted by TCBA to participate in the mission trip, and as consideration for TCBA assisting in arranging the mission trip, and for other goods and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby irrevocably and unconditionally release, waive, discharge and covenant not to sue or attach the property of TCBA or any of their affiliates, subsidiaries, mission agencies, mission affiliates, divisions, affiliated churches, members, directors, officers, employees and agents (collectively referred to as the “Releases’), for and from all claims of any nature now or hereafter existing whether known or unknown, including but not limited to all liability, on account of death, injury, or damage resulting from the negligence or other acts, however caused, of the Releases as a result of my participation in the mission trip. I UNDERSTAND THAT I AM GIVING UP MY LEGAL RIGHTS AND THE RIGHTS OF MY REPRESENTATIVES TO RECOVER FOR INJURY, DEATH, OR PROPERTY DAMAGE.                                                                                                                                                                            Knowing and voluntary execution.                                                                                                                          I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and contract between myself on the one hand, and Tri-County Southern Baptist Association, and/or their affiliates on the other hand. No oral representations, statements or inducements apart from this agreement have been made to me.  By submitting this agreement of my own free will.                                                                                                               Applicant Statement (all applicants must submit the following registration):                                                              The information contained in this application is correct to the best of my knowledge.  In consideration of this evaluation by TCBA, I hereby release any individual church, youth organization, charity, employer, reference or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or family, on account of compliance or any attempts to comply with this authorization. Should my application be accepted, I agree to be bound by the Bylaws and policies of TCBA and to refrain from unscriptural conduct in the performance of my services on behalf of TCBA. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SUBMITTED THIS RELEASE AS MY OWN FREE ACT. This is a legal binding agreement which I have read and understood. *
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