2017 Baja Winter Mission Parent/Guardian Questionnaire
Child's Name *
Your answer
Child's Age *
Your answer
Parent/Guardian Name *
Your answer
Current Grade Level *
Your answer
Parent/Guardian Phone Number *
Your answer
Email Address *
Your answer
Home Address (Street, City, State, Zip Code) *
Your answer
Are you supportive of your child attending this mission trip? Why or why not? *
Your answer
What medications/medical or health requirements does your child have (if any)? *
Your answer
Does your child have any other requirements and/or limitations that must be taken into consideration to allow for his/her participation (e.g., court requirements, legal, medical, etc.)? *
Your answer
Please include any other information/thoughts you would like to share to help us make the decision on including your child. *
Your answer
HEALTH DISCLAIMER *
Should my child require any medical treatment (emergent or not) for any reason, I allow the medical staff on board to assist my child with his/her medical needs.
Required
RESPONSIBILITY STATEMENT AND LIABILITY DISCLAIMER *
I allow my child to participate in any activities set forth by the Baja Mexico Mission Trip. I understand the terms and conditions of this application and my child's participation in the trip. I understand the possible risks involved. In consideration of my child's participation, I agree to release Baja Mission Leadership and staff involved from any and all liability, loss, and/or injury to person or property suffered by any person in connection with this trip.
Required
By participating in this mission trip, I acknowledge that any photos/videos may be used for publicity purposes. *
Required
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