Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Landline or

Cell

Birthdate *

MM

DD

YYYY

Gender *

Male

Female

T-shirt size *

(available in adult sizes only)

XS

S

M

L

XL

XXL

Passport Expiration Date *

MM

DD

YYYY

Date of last Tetanus shot: *

MM

DD

YYYY

Date of last Hepatitis A shot (recommended):

MM

DD

YYYY

Date of last Hepatitis B shot (recommended):

MM

DD

YYYY

Do you require any ACCOMMODATION?

Disabilities or medical/physical/mental conditions.

Yes

No

Do you currently have out-of-country insurance? *

Please note: It is a mandatory requirement and the responsibility of all participants to ensure that they have out-of-country health insurance for the duration of our trip, including travel days.

Yes (please continue filling out this section)

Not yet, but I will!

Does your insurance company require pre-authorization for medical treatment?

Yes

No

LIABILITY WAIVER / AUTHORIZATION / RELEASE / COVENANT *

DIG Guatemala Service Trip February 2026 In consideration of being allowed to participate in this project sponsored by Mountainview Christian Reformed Church (CRC) and in consideration of the benefits to be derived there-from, I hereby release Mountainview CRC and its present and former trustees, officers, directors, shareholders, employees, agents and their heirs, administrator, executors, successors, and assigns from all claims and liabilities of any kind, whether known or unknown, which arise from or are connected in any way with my/my child’s participation in this trip. I recognize that the conditions in some of the places to which I/my child will travel are not of the same standard as the conditions to which I/they are accustomed, I realize further that there are certain health risks as well as other risks I/my child will be exposed to while participating on this project. I fully acknowledge those risks. If for any reason I/my child am/is unable to complete my/his/her stay at the project, I assume full responsibility for the expenses incurred for my/his/her return home. I am also aware that any lack of respect for authority, including the use of abusive language, abuse alcohol, and failure to comply with behavioral expectations may result in my/his/her being sent home at my expense. I understand that any use of firearms, weapons, or drugs (not prescribed by a physician) will automatically result in my/his/her being sent home at my expense. In the event of an emergency, I hereby authorize a leader of this activity, as an agent for me, to consent to: any x-ray examination, medical, dental or surgical diagnosis; treatments; hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state or country where services are rendered, either at a doctor’s office of in a hospital. I expect my emergency contact/I will be contacted as soon as possible. I understand that this document constitutes a full and complete waiver of all possible claims for any act of omission, including claims for negligence regarding injury or property damage, arising out of my/my child’s participation in the trip. I understand that this release applies to, covers and includes unknown, unforeseen, unanticipated, and unsuspected damages, losses or liabilities and the consequences thereof, which results from the matters herein before inferred to as well as those now disclosed and known to exist. The provisions of any state, federal, local, provincial or territorial law or statute providing in substance that releases shall not extend to claims or damages which are unknown or unsuspected to exist at the time are hereby expressly waived by me.

I AGREE

ALL PARTICIPANTS AND PARENT GUARDIANS (for those under 18) *

I agree to cheerfully participate in all assignments and activities and to abide by decisions and schedules set by the Mountainview CRC host team and adult sponsors. I acknowledge that I am representing Jesus Christ and Mountainview CRC while on this mission trip and will conduct myself appropriately at all times. I do hereby certify that I promise to abide by the rules and regulations set forth therein.

I AGREE

CERTIFICATION / E SIGNATURE *

By selecting I agree and registering, I certify that all information in this application is correct and that I have read, understood, and agreed to all the provisions of the Liability Waiver/Authorization/Release/Covenant as stated.

I AGREE

Date

MM

DD

YYYY