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International Waiver and Release
Every International Mission Trip Participant must complete the following Waiver/Release form prior (30 days prior if possible) to trip start date. Contact the Hope Missions office with any questions.
International Waiver and Release
Please fill out the form and click the submit button.
International Location
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Choose One:
Cuba
Haiti
Nicaragua
Costa Rica
Panama
Philippines
Brazil
Israel
Trip Date
*
PERSONAL / MEDICAL INFORMATION
I affirm that the information listed below is complete and accurate to the best of my knowledge.
Name as it appears on Your Passport
*
Please enter name exactly as it appears on your Passport
Name you go by
Date of Birth
*
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Birthplace
Citizenship
*
Address
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Street Address
*
Address Line 2
City
*
Province / State / Region
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Postal Code / Zip
Antigua and Barbuda
Bahamas
Barbados
Belize
Canada
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Nicaragua
Panama
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Columbia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Côte d\'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country
*
Phone
*
Best number to reach you. Cell phone number preferred
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Your Email
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Marital Status
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Choose One:
Single
Married
Gender
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Choose One:
Male
Female
Passport Number
Country Issued
Expiration Date
Must be valid at least six months prior to trip start date. If not, you must submit for a new passport.
MM
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DD
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T-Shirt Size
*
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Emergency Contact Name and Number
*
Do you have any medical condition(s) that we should be aware of? If so, please list details below.
Are you taking any medication that we should be aware of? If so, please list details below.
Insurance Company
Group Number
Primary Policy Holder's Name
Policy Number
Additional Question/Comments
ACKNOWLEDGMENT, ASSUMPTION, and RELEASE
Please read the following agreement and waiver carefully. It includes releases of liability and waiver of legal rights, and deprives you of the ability to sue certain parties. By agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the registration process.
I, the undersigned, wish to participate in a short-term mission project in the country selected above conducted under the auspices of Hope Missions. By signing this form, I acknowledge (1) that travel to and in the country selected above involves hazards not customarily encountered when traveling in America. (2) Medical facilities in the country listed above are substandard and that should a medical emergency develop during my trip, it is unlikely that I will receive medical care in the country listed above equivalent to that available in America. (3) Working conditions in the country listed above are often inferior to conditions in America. (4) Hope Missions does not carry insurance to insure against any of the risks I may encounter in the country listed above.
Despite the foregoing, it is my desire to participate in the work in the country selected above, and I knowingly assume the risks that are involved and release Hope Missions, its employees and agents, from any liability for injury, damage, or harm which may occur to my person or property while traveling in connection with this project or otherwise participating in this project.
I affirm that I am eighteen (18) years of age or older, or the parent/guardian of the participant if under eighteen years of age, and that this Acknowledgment, Assumption, and Release is binding on me and my executor, administrators, and heirs. I give Hope Missions and it's representative(s) with me on any such trip authority to request and authorize medical and/or hospital treatment for my benefit in the event of any injury or sickness sustained by me while on such ministry activity, including, without limitation, while traveling to and from any foreign country. I agree to pay for all such treatment and to reimburse Hope Missions for all costs and expenses incurred by it with respect to such treatment.
By entering my name below, I assert that I have reviewed and agree to all of the waivers and agreements above.
Electronic Signature - Full legal name
*
By checking below you are agreeing to a digital signature and acceptance
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Agreed to and Accepted
Today's Date
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