TEAM REGISTRATION FORM

Every potential team member needs to fill out a registration form and send it in to us with a $40 registration fee (which is non-refundable and non-transferrable). It will be used for administrative expenses in planning your team.

Please fill out the form on this page and hit “Submit” at the bottom.

Instructions: Answer all questions below and after you hit "Submit", your completed form will be sent to us. We consider this information to be very important in helping make this missions trip a success for you!

NOTE: Your legal name (below) should be as it appears on your Drivers License - (VERY IMPORTANT for your airline ticket)

Please list a character reference whom we may contact:

In case of an emergency, list a primary contact or someone we need to reach:

Enter your Primary Physician information:

Verification of Medical Insurance Coverage

Psalm 72 (PS72) requires that all team leaders and team members have adequate medical insurance.

Some family health insurance policies cover short-term travel; some do not. You must verify with your insurance carrier that your current policy will cover you while on the mission for which you are applying. If you do not have health insurance for this trip, we can suggest a company that will offer insurance just for your team assignment.

RELEASE OF LIABILITY AND RELEASE TO OBTAIN MEDICAL CARE

Matthew 18:15-20 and I Corinthians 6:1-8 instructs us to live at peace and to resolve disputes in private or within the Christian church. I acknowledge my concern that the limited charitable resources of PS72 should not be dissipated on wasteful litigation. Therefore I expressly waive my right to file a lawsuit in any civil court or other secular setting against PS72 and other organizations and all individuals involved with this mission trip.

I hereby release all leaders and organizations involved with this mission trip from any and all legal liability. I hereby waive all my rights to any legal liability, on the part of PS72 or any other individuals or organizations involved, which liability may result from sickness, injury, or death that may occur on or relate to this trip. I fully realize that there are hazards, and I am fully assuming these risks, including but not limited to, hazardous travel, poorly constructed roads, animal attacks, dangers resulting from military or political activities, sickness, disease, inadequate health care, kidnapping, arbitrary imprisonment, and all other unforeseen risks.

I specifically release PS72 and all concerned from any claim of negligence in their duties as leaders, or otherwise, on this mission trip. In the event that I attempt to make a claim in violation of my release and waiver as herein indicated, I hereby agree to, and shall pay, all legal fees and costs incurred by PS72 and other individuals and organizations involved.

I hereby further acknowledge my responsibility to provide my own insurance coverage of any and all types, including but not limited to, medical, hospitalization, life, disability, death, lost baggage, lost or stolen personal property, and any and all other insurance which I may need or desire. I also hereby release PS72 and all leaders and organizations involved with this mission trip from responsibility to provide insurance coverage of any and all types.

I hereby further authorize the leadership of PS72 to make essential decisions on my behalf with respect to medical treatment, emergency surgery, or hospitalization, should such be necessary. However, PS72 shall in no way be responsible or liable for payment of any and all bills for such medical treatment. I assume the full responsibility for any and all medical bills incurred related to this outreach. My estate and my family shall further assume full and total cost for the return shipping of my body should I die by any cause on this trip.

I further agree wholeheartedly to abide by decisions made by leaders and all those in authority and by all guidelines, policies, and rules pertaining to this trip, including but not limited to PS72 team policies.

I have read and am in full agreement with this release and waiver, and fully understand that I am: waiving any rights I may have to litigate and sue; accepting full responsibility for all insurance, all medical costs, and all risks related to this trip; authorizing PS72 to make medical decisions if necessary; and agreeing to read and abide by all guidelines, policies, rules, and leadership decisions pertaining to this outreach.

I certify that all the information I have given on this team registration form is accurate and true to the best of my knowledge.

By signing this form, I acknowledge that I understand and agree with everything stated on this form.