Address

The primary goal of our trips is to share the gospel and plant churches. Therefore, we ask as a
Team Member that you be a believing Christian and a member of a local church body.)

For International Trips Only

(must be valid six months after last day of trip)

On our “Health Questionnaire” make sure you fill out clearly the portion dealing with emergency contact. We will also need a clear photocopy (especially the picture and number) of your passport.

Below list areas of work you either have experience in doing or would be willing to do:

Church Missions Network Health Questionnaire

Address

Emergency Contact One

Emergency Contact Two

Medical History:

Insurance

Doctor

I understand the information I have provided will be held in strictest confidence and will be used only in the event of a medical emergency. The only persons who will have access to this information will be the team captain and medical team leader. I give my permission to the medical team leader to share my medical history with local medical professionals only in the event of a medical emergency. I give my permission to contact my physician should a medical emergency arise. I further understand all that is physically required from me for this trip and to the best of my knowledge I am physically able to perform all tasks that will be required.

CHURCH MISSIONS NETWORK

P.O. BOX 2940
Lebanon, Tennessee 37088

General Release/Hold Harmless Agreement for the Church Missions Network

The undersigned desires to participate in various programs, events, trips or activities (hereinafter collectively referred to as "Activities") operated, or sponsored by CHURCH MISSIONS NETWORK (Hereinafter referred to as the "CMN Organization").

The CMN Organization regularly participates in group international travel activities. The undersigned understands and acknowledges that a participant may incur personal or bodily damage while participating in these activities, and assumes all risks inherent in these activities and accepts full and complete responsibility for any and all damages or injury of any kind. The undersigned further understands and acknowledges that the CMN Organization would not allow an individual to participate in such activities without releasing and holding harmless the CMN Organization. Further, the undersigned requests that the CMN Organization allow him/her to participate in CMN Organization activities and in consideration thereof agrees to hereby release and forever discharge CMN Organization, its officers and directors, and its employees, agents and any parties volunteering on behalf of the CMN Organization, from all actions, claims, damages, costs, liens, expenses, or lawsuits of any kind growing out of, or related to any Activities of the CMN Organization in which the undersigned participates.

The undersigned further acknowledges that this is a full and complete release for all injuries and damages which the undersigned may sustain as a result of the undersigned's participation in any CMN Organization activity.


Participant:

Address

(parent or legal guardian signature required if No.)