Cell Phone # *

(###)

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Fields of Interest (Multiple Choices)

Multiple fields can be chosen. The mission leaders, however, might assign different ministries to you based on the need.

Kids

Sisters

Check the box if you speak Spanish

Speak Spanish

Name on Passport or Green Card (Below is The Information Required for Mission Trip Insurance) *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Passport Expiration Date *

MM

DD

YYYY

Release of Liability and Consent to Treatment *

Liability Release and Indemnification Agreement I intend to participate in the Mexico Mission Ministry and related activities sponsored by Beacon Community Church, EMCI, and partner churches. I acknowledge that such participation involves inherent risks and hazards, including but not limited to travel-related risks, overnight stays, safety concerns, health hazards, accidents, and potential exposure to criminal or violent situations. In recognition of the privilege extended to me by BEACON COMMUNITY CHURCH, EMCI, and partner churches, including their officers, agents, employees, and representatives, I hereby release, discharge, and hold them harmless from any and all claims, demands, liabilities, injuries, illnesses, damages, losses, or deaths that may arise in connection with my participation in this mission trip. I further agree to indemnify and hold harmless Beacon Community Church, EMCI, and partner churches from any legal claims, lawsuits, expenses, or damages resulting from my involvement in the program. If any expenses arise due to my actions or circumstances during the trip, I accept full responsibility for reimbursement. Additionally, I authorize the mission team leadership to consent, on my behalf, to any necessary medical procedures or treatments deemed advisable by licensed medical professionals in the event of an emergency. This authorization extends to any hospital or medical facility providing treatment, with the understanding that decisions will be made by the designated mission team leader(s). This authorization remains in effect until revoked in writing and submitted to the designated mission team leader.

I agree to the liability and consent to treatment