Guatemala 2023 Application
All Guatemala volunteers must complete the below application, sign the included waiver, and submit a deposit by May 15th to fully reserve their spot.

Should you have any questions or trouble completing the below, please contact and
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Full Name (As it appears on your passport) *
Preferred Name (for name tags, etc.)
Email *
Phone number *
Address *
Preferred Phone # *
Date of Birth *
Passport # *
Passport Expiration Date *
Gender *
T Shirt Size (Adult, Unisex) *
Emergency Contact (Name, Phone) *
Which week will you be traveling with us? *
Desired Activities *
Special skills outside of activities listed above:
Spanish language capability *
Overall Health *
If health listed as "Poor" above please provide additional detail:
Do you have any physical disabilities/concerns that could hinder your work? (Yes/No) (If yes please elaborate)
Date of last tetanus immunization
Drug or food allergies

Short-Term Mission Trip Release of Liability and Permission Regarding Medical Care 

1. Introduction

This is a release of liability and an authorization regarding medical care and the use of photographs of me. By signing below, I am agreeing to release Beyond the Walls (BTW) and its representatives from liability. I am also granting permission to BTW and its representatives to seek and obtain medical care in the event of my illness or injury. I have, therefore, been advised to read this document carefully and understand that I have the opportunity to consult with an attorney before signing.

It is my understanding that participation in this Short Term Mission Trip (Trip) to Guatemala sponsored by Beyond the Walls is a privilege. I also acknowledge that one reason that I am participating in the Trip is to obtain spiritual and other benefits afforded by BTW that are in accordance with its goals.  In consideration for the privilege of participating in this Trip, I am signing this Release of Liability and Permission Regarding Medical Care form (Release). I acknowledge that my participation in this Trip may involve certain risks of physical injury, illness, or death, including risks of which I may not currently be aware, and I hereby agree to assume such risks.

2. Release and Indemnification

I hereby agree to release and hold harmless BTW, members of its governing board, and its officers, employees, members, volunteers, and agents (collectively, “the Released Parties”) and to discharge and waive any and all claims, demands, losses, damages, and liabilities with respect to any and all property damage, personal injury and/or death arising from my participation in this Trip. The foregoing sentence shall apply (without limitation) to all claims, demands, losses, damages, and liabilities described therein, whether known or unknown, foreseen or unforeseen, future or contingent, except claims, demands, losses, damages and liabilities arising out of the sole and exclusive gross negligence or willful misconduct of one or more of the Released Parties. I further covenant not to sue any of the Released Parties in connection with any of the claims, demands, losses, damages, or liabilities described above.

I further agree to indemnify, save, and hold harmless the Released Parties from any and all claims, demands, losses, damages, and liabilities for indemnities, contribution or other otherwise with respect to any and all property damage, personal injury and/or death arising from my participation in this Trip, as may be asserted by a third party (defined as any party other than the Released Parties or me), except to the extent such a claim might be based upon the sole and exclusive gross negligence or willful misconduct of one or more of the Released Parties.

3. Authorization for Medical Care

I attest and certify that I have no known medical conditions that would prevent me from participating in this Trip. I understand that BTW provides insurance coverage that is intended to cover emergency medical expenses associated with accidental injury or illness not related to a pre-existing condition that may occur while I am outside the United States.

In case I am in need of medical or surgical treatment to protect my health and welfare while participating in this Trip, I authorize and agree to allow any authorized agent or employee of BTW to consent to and authorize the administration of such necessary medical and/or surgical treatment. I acknowledge and agree that the release of liability, hold harmless, and indemnification provisions set forth in Section 2 above shall apply to any authorization and consent to medical or surgical treatment made on my behalf by BTW or its authorized agents or employees. If I am a minor or a signatory to this Release for a minor, I understand that efforts will be made to contact a parent/guardian before these actions are taken, but that in an emergency such actions may be taken in the event a parent/guardian is unable to be contacted. 


BTW and I agree that, should a claim or dispute arise from my participation in this Trip, it shall be settled by biblically based mediation and, if necessary, legally binding arbitration under a mediation or reconciliation process in accordance with the Guidelines for Christian Conciliation and associated Rules of Procedure promulgated by Peacemakers Ministries Inc. of Billings, Montana, USA, or its successor. The venue for such mediation, conciliation and arbitration process shall be Mendham, New Jersey, or such other location as agreed upon by both parties. Judgment upon an arbitration award may be entered in any court otherwise having jurisdiction.


I grant to Beyond the Walls, Potter’s House—Guatemala, and Potter’s House--International permission to use in their printed materials and on their respective web sites and other digital media photographs and/or videos taken of or by me during the Trip or during trip-related activities. 

I expressly waive any defense to the enforcement of any provision of this Release arising from a claim of lack of consideration. In the event that any provision of this Release is determined to be invalid or unenforceable, the remainder of the provisions shall remain in full force and effect as if this Release had been executed with the invalid provision eliminated. I understand and agree that this Release is intended to be as broad and inclusive as permitted under applicable law.

The undertakings and covenants of this Release shall be binding upon me, my family, heirs, next of kin, legal representatives, beneficiaries, successors, and assigns. This Release shall be interpreted in accordance with the laws of the State of New Jersey. The terms of this Release are contractually binding and are not a mere recital.

This Release shall be effective and binding upon me. I have read this Release and understand its terms. I further represent that I am at least 18 years of age and am not a minor in my State of residence or, if I am a minor in such State, that both of my parents or my legal guardian have signed this form in the Consent section below acknowledging this Release and accepting its terms on my behalf. 

Please read and confirm consent/digital signature to below liability waiver: *
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