2019 STETSON Ministries Dominican Republic Trip Application
Email address *
Your full name as it appears on your passport *
Your answer
Nickname you prefer
Your answer
Passport number *
Your answer
Date of Birth *
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DD
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YYYY
Mailing address (number and street name) *
Your answer
City, State, Zip *
Your answer
Phone number *
Your answer
Do you text at this number? *
Gender *
Marital status
T-shirt size *
Are you a medical doctor, nurse, or other medical professional? *
Have you traveled with STETSON Ministries before? *
Church affiliation
Your answer
Do you have any allergies or other items to tell us about?
Your answer
Emergency Contact and Relationship to them *
Your answer
Emergency Contact Phone Number *
Your answer
For the appropriate liability release below, agree by typing your name as your signature in the space provided.
Adult Liability Release: By typing my name below, I hereby agree that I will voluntarily be taking part in a STETSON Ministries Missions trip being taken by STETSON Ministries from June 2, 2018, through June 10, 2018. I am over the age of eighteen and understand and agree that neither STETSON Ministries, its officers, nor any of its staff members may be held liable in any way for any occurrence in connection with the mission trip that may result in injury, death, or other damages to me or my family, heirs, or assigns. I agree further to save and hold harmless STETSON Ministries, its officers, and its staff members from any claim by me, my family, estate, heirs, or assigns, arising out of my participation in this STETSON Ministries Mission Trip. I exempt and release STETSON Ministries, its officers, and its staff members from all liability whatsoever for personal injury, property damage, or wrongful death caused by negligence. **If the trip member is under eighteen, just type N/A in the blank and use the young adult liability release form.** *
Your answer
Young Adult Liability Release: Since the participant is a young adults under eighteen years of age, I, the parent or legal guardian, is signing the liability release form. By typing my name below, I hereby agree that my young adult will voluntarily be taking part in a STETSON Ministries Missions trip being taken by STETSON Ministries from June 2, 2018, through June 10, 2018. I agree that neither STETSON Ministries, its officers, nor any of its staff members may be held liable in any way for any occurrence in connection with the mission trip that may result in injury, death, or other damages to my young adult. I agree further to save and hold harmless STETSON Ministries, its officers, and its staff members from any claim by them arising out of the participation of my young adult in this STETSON Ministries Mission Trip. I exempt and release STETSON Ministries, its officers, and its staff members from all liability whatsoever for personal injury, property damage, or wrongful death caused by negligence.
Your answer
Since this is an application, participation on this trip is not guaranteed. STETSON Ministries will contact you about this application.
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