MS Mission 2017 - NOLA
June 4 - 11, 2017 | $650 (Deposit is $325)*

This summer our Middle School students will head to New Orleans, LA and the surrounding areas for our mission trip! In August 2016, prolonged rainfall in Louisiana resulted in catastrophic flooding that submerged thousands of houses and businesses. We will be working with a Louisiana-based Christian organization, aiding the clean up and rebuild after this devastating flood. Our mission group will work hard serving families in need, and as always we will find fun activities to experience in the area.

*Financial Aid is available; please complete the application at fpchouston.org/youth. Payment may be made on the FPC HS Youth web page at fpchouston.org/youth

Last Name of Student
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First Name of Student
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Gender
DOB (MM/DD/YYYY), example: 05/01/2000
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Student's Cell #
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School
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Grade Level (completed)
Names of 3 friends on trip:
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T-shirt size (ADULT sizes only)
Parent Contact Info: Father NAME
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Parent Contact Info: Father CELL #
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Parent Contact Info: Mother NAME
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Parent Contact Info: Mother CELL #
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Father Email Address
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Mother Email Address
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Other Emergency Contact (Name, Cell #, Relationship)
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Student's Physician (Name & Cell #)
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Allergies & Dietary Restrictions (include details for treatment)
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If Student takes any medications, please give Name, Dosage and Time Taken
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Medical Insurance Company
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Medical Insurance Phone #
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Medical Insurance Policy #
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Medical Insurance Group #
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I plan to apply for Financial Aid and understand the Application needs to be turned in immediately. (Application is on the FPC Youth web page).
TRAVEL RELEASE - I hereby authorize my child to travel with the First Presbyterian Church Youth Leaders from 6/4/17 - 6/11/17 and I give authorization to the adults serving on behalf of FPC Houston to act as my agents.
Required
MEDICAL RELEASE - In an emergency, I give my permission to any physician, dentist or health care attendant: 1) to secure proper intervention, x-ray examination, medical or surgical diagnosis and treatment, anesthesia, hospitalization, and any other medical attention for my youth; and 2) to communicate with any FPC youth leader accompanying my youth.
Required
LIABILITY RELEASE - As the parent or legal guardian, I agree to assume and accept all risks and hazards inherent in any FPC Youth Ministry Activity in which my youth participates. I agree NOT to hold First Presbyterian Church of Houston (FPC) or its employees or its volunteer assistants liable for damages, losses, or injuries (harm) to my youth or his or her property, including harm resulting from negligence of FPC or negligence of any FPC employee or FPC volunteer. I understand that I am signing for the youth listed on this form and my signature completely releases FPC, its employees and volunteer assistants from all claims, damages, and liabilities, including bodily injury and death, as a result of this activity or due to the negligence of First Presbyterian Church or its employees or volunteer assistants.
Required
FINANCIAL POLICIES - I understand that a deposit is required to secure my child's spot, and that I'm responsible for paying the balance by MAY 1, 2017. CANCELLATIONS - all cancellations will incur a cancellation fee of $250. Cancellations must be made before MAY 15, 2017 in order to receive a refund (less the cancellation fee). Cancellations made after May 15, 2017 waive the right to a refund.
Required
BEHAVIORAL EXPECTATIONS - My child and I understand that behavioral expectations are laid out to students on the first day of the trip and I expect my child to adhere to these expectations throughout the duration of the trip. In the case that my child does not adhere to these expectations, FPC Leaders at their sole discretion may determine the appropriate consequences for their behavior, which may include sending my child home (at my expense). I also accept financial responsibility for any damages caused by my child during the course of this trip.
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