LCM-TC Waiver and Liability Form 2020-2021
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By initialing this, I am indicating that I understand that there are inherent risks involved in any retreat or spring break trip, and I hereby release Lutheran Campus Ministry-Twin Cities and volunteers from any and all liability due to any injury, loss or damage to person or property that may occur during the course of the retreat or spring break trip.  Should emergency medical treatment be necessary and my emergency contact is unable to be reached, I authorize the chaperones to act on my behalf and approve the appropriate treatment. *
By initialing this, I commit to following all of LCM's established Covid protocols, including but  not limited to masking, distance, checking in, and staying home if I'm even just a little sick!  LCM will send a detailed reminder of our Covid protocols to you ahead of the retreat.  
Name (First, Middle and Last) *
Address (Street, City, State, Zip) *
Dietary Restrictions *
Please list allergies to food and medicine
Please list medications being taken
Name of Insurance, Policy Number and Group Number *
Emergency contact information #1 (include name, relationship, cell phone, and home phone - if there is one): *
Emergency contact information #2 (include name, relationship, cell phone, and home phone - if there is one): *
We love to share pictures of our community (you included!) on our website and social, and also in our print communications.  Is this okay with you?
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For international trips only, what is your Passport Number, expiration date, and where was it issued from?  Please also make sure you take a picture of it and email it to Pastor Kate.
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