Mission Forms - Fill out all information

Date of departure

MM

DD

YYYY

Official Name as it appears on passport *

First and middle together

First Name

Last Name

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Information *

I have a Valid Passport

I Have Applied For a US Passport

Emergency Contact Name (E.C.) *

First Name

Last Name

E.C. Phone *

Country

(###)

###

####

How Would You Like to Serve *

You can check more than one

Im Not Sure

Physician / P.A.

Nurse

Pharmacy

Triage

Evangelism

Children's

Kitchen

Pastors Conference

Photographer

LADIES HYGIENE

MID WIVE TEACHER

SOCCER CLINIC PROFESSIONALS

Do you Attend A Local Church *

Yes

No

2. Is this your first mission experience?

Yes

No

Team Covenant *

I understand trip dates, location and cost may change due to circumstances beyond the control of MedReach, Inc. and agree to any reasonable changes. I will comply with all team requirements and attend all Training and Prayer Meetings unless providentially hindered. (You are very much encouraged to attend all team functions. Bonding together in team unity is important in a very practical sense for efficiency and effectiveness on a medical mission. But unity is also extremely important for our Christian witness. “By this everyone will know that you are my disciples, if you love one another.” Jn. 13:35) I place myself under the supervision of the Team Leader(s). If I create problems on the trip, I grant permission to be sent home at my own personal expense with no refunds.

I have read, understood, and voluntarily agree to the terms of The MedReach, Inc Team Covenant. By checking this box and entering my name below, I acknowledge my full and informed consent.

Team Policies *

Realizing that the following elements are crucial to the smoothness and safety of our mission, as a team member I agree to: a. Remember that I am a guest working at the invitation of a local missionary, pastor, medical clinic, or other host organization. Realizing that my team will be in the location for just a short time but that the host organization will be there for the long term, I will do nothing to harm my hosts' relationship with the people to whom they minister. I will "become all things to all men, if by all means I might save some." If people are offended by bare arms, shirtless backs or exposed legs, I will cover them. If they offer me goat meat stew, I will try it, remembering the missionary's prayer: "Where You lead me, I will follow; what You feed me, I will swallow!" b. Remember that I have come to serve. If I run across procedures that I think are inefficient, or attitudes that I think are poor, I will resist the temptation to inform people about "how we do things!" I will be open to learn about people's ideas and ways. c. Develop and maintain a servant attitude toward all nationals, our host and my teammates, remembering that I am to be like my Lord, who "came not to be served but to serve!" d. Respect my team leader(s) and obey instructions immediately and joyfully. e. Refrain from gossip. People blossom when freed from the concern that others may be talking about them. f. Refrain from complaining. I know travel can present many unexpected and undesired circumstances, but rewards of conquering such circumstances are great. Instead of whining and fussing, I will be creative, supportive, cooperative and flexible. g. Attend all team preparation classes and follow-up meetings so far as I am able. h. Fulfill all logistical requirements. I will comply with deadlines for forms, passports, shots, etc. i. Refrain from negative political comments or hostile discussions concerning the host country. j. Remember not to be exclusive in my relationships. I will not form cliques that exclude other team members. If my sweetheart or spouse is on the team, I will make every effort to interact with all members of the team, not just one another. If I am attracted to a teammate; I will not attempt to pursue an exclusive relationship until we return home. I will refrain from any activity that could be construed as romantic interest toward a national. Certain things that seem innocent enough in my own culture could be quite inappropriate in others. k. Abstain from the use of alcoholic beverages, tobacco or other so-called "recreational”/ illegal drugs while on the trip and while traveling to and from our destination. l. Ladies: Wear a skirt to church meetings and Jesus Film Showings. m. Give no monies to any national or make any promise of any money for school fees or any other support. I will not indicate by my words or actions any intentions to help any national travel out of his country. I Agree to the payment schedule set forth by MedReach, inc.

I have read, understood, and voluntarily agree to the terms of these Team Policies. By checking this box and entering my name below, I acknowledge my full and informed consent.

Release Form *

I do hereby consent to participate in a trip which has been arranged by MedReach, Inc. an Alabama non-profit corporation. In consideration of MedReach, Inc. making arrangements for this trip I hereby agree as follows: A. I am responsible for my own immunizations. I understand lists of required and recommended immunizations for the country I visit are issued, updated, and maintained by the International Mission Board of the Southern Baptist Convention, the United States Government; and immunizations are administered by my local County Health Department, private physicians, and others. I acknowledge that I have a specific health history and needs and will review the referenced lists of required and recommended immunizations and sources, with my independent health professional, if necessary, to determine immunizations and sources that are required for my particular situation; and will be responsible to obtain necessary immunizations. B. In the event that I require medical and/or dental treatment while on the mission project or traveling to or from the project, I hereby consent and give my permission to the mission leader to consent to any X-ray; injections; anesthesia; medical, dental or surgical diagnosis and treatment advised and supervised by a physician; surgeon or dentist licensed to practice under the laws of the nation and state where the services are rendered, either as an outpatient or in any hospital. C. I hereby release MedReach.Inc. or if applicable, the Church (which term shall also include its Pastors, Trustees, employees, agents, and shall also include all members of the Church as well as any other entity which might be affiliated with the Church) from any and all responsibility or liabilities in the event of illness, injury or death during the period of travel from the time of departure to the time of return or from the result of any event during the period of travel, not the direct and proximate result of the willful and wanton negligence of MedReach, Inc., or if applicable, the Church or its Pastors, Trustees, employees agents, or members on account of any such illness, injury or death. D. I agree to indemnify and hold harmless MedReach, Inc., or if applicable, the Church, its Pastors, Trustees, employees, agents, and members from and against any claim or liabilities, including the cost of defense, asserted on my behalf or on behalf of any third party, of any nature whatsoever and whether in tort or contract, or otherwise. E. I hereby acknowledge that MedReach, Inc., or, if applicable, the Church is acting solely in the context of facilitating travel arrangements, orientation and providing indirect logistical support for this trip and should in no way be deemed to be liable for any loss or damage resulting from changes in the itinerary of said trip, that is not the result of the willful and wanton negligence MedReach, Inc., or, if applicable, of the Church.

Myself - I hereby acknowledge that I have read, understood, and agree to the MedReach, inc "Release Form" terms and conditions. I further agree to release and hold harmless MedReach, Inc., its officers, directors, employees, volunteers, and affiliates from any and all liability, claims, demands, or causes of action, whether known or unknown, arising out of or related to my participation in any activities or events, to the fullest extent permitted by the laws of the State of Alabama.

Parental/Guardian Acknowledgment & Release - I, the undersigned parent or legal guardian of the minor child named below, hereby acknowledge that I have read, understood, and agree to the MedReach, inc "Release Form" terms and conditions on behalf of myself and said minor child. I further agree to release and hold harmless MedReach, Inc., its officers, directors, employees, volunteers, and affiliates from any and all liability, claims, demands, or causes of action, whether known or unknown, arising out of or related to my child’s participation in any activities or events, to the fullest extent permitted by the laws of the State of Alabama.

Statement of Truth *

I do hereby attest that all information provided in this form is true, complete, and accurate to the best of my knowledge and belief. I affirm that I am of sound mind and acting of my own free will, and I understand that this statement is made under penalty of law and is legally binding to the fullest extent permitted by the laws of the State of Alabama