APPLICATION FOR MISSION TRIP TO CHIAPAS: February 2022 Two forms must be submitted – this mission application and the COVID-19 Waiver. Please type your full name (first and last) where requested under each statement and it will serve as your signature. Nickname for Name Badge Home Address * City * State * Zip Code * Home Phone Cell Phone Work Phone Email * Date of Birth * Age * Passport Number * Date of Issue * Expiration Date * Home Airport Place of Employment * Occupation * Do you speak other languages proficiently enough to serve as an interpreter? If yes, please specify languages you speak Church regularly attending, if any Are you willing to give a 5 to 10 minute morning devotion? If you are not a medical professional, are you interested in participating as a Helping Hand in any of the areas listed below: Type of License License Number Years of Experience Glove Size: Small Medium Large FOR ALL APPLICANTS PLEASE ANSWER THE FOLLOWING QUESTIONS Please specify your size for a Team Men’s T-shirt or Button Down: Small Medium Large X-Large XX-Large XXX-Large How did you hear about Project Compassion? Is this your first mission with Project Compassion? Yes No Please tell us about a previous mission and or cross-cultural experience you have had. What are you hoping to get out of the mission trip? Do you have specific skills you would like to use on the trip? Do you have any physical limitations? * Yes No If yes, please explain: Do you have a history of medical problems requiring on going treatments? * Yes No If yes, please explain: Are you currently taking any medications? * Yes No If yes, please list: Do you have any allergies to food or medication? * Yes No If yes, please list: Please provide your Primary Care Physicians Name and Phone Number In case of an emergency notify, * Relationship Phone Number Participants Insurance Company Policy # PLEASE READ THE STATEMENTS BELOW AND ATTEST TO YOUR UNDERSTANDING OF THE STATEMENT WITH YOUR SIGNATURE OR INITIALS I have read and agree with the Mission Statement, Vision Statement and Statement of Belief of Project Compassion (linked below). Please agree by selecting the checkbox. * I have read and agree with, signed and submitted the COVID19 Waiver. * If you do not concur with the Project Compassion Agreement, please explain why. I agree to conduct myself in compliance with Project Compassion principles and team policies at all time while among the team members, with the hosts and with those whom we serve. I understand that failure to do so may result in my return to the United States on the next available flight. FULL NAME * Date * Please initial in the box below each statement.
If this is your first Mission Trip with Project Compassion a $50 non-refundable application fee is due. Please send a $50 check made payable to Project Compassion or payment can be made through our website at
Upon approval of my application and receipt of my $50 application fee if applicable, a $300 non-refundable deposit is due to reserve my space on the team and will be applied to the costs of my trip. * Airline tickets or other outreach expenses will not be paid for me unless my Project Compassion trip account payments are up-to-date. * Included air travel costs are based on departures from San Diego or Los Angeles International Airport. * Airlines have varying fee structures for baggage, based on international flights. On Project Compassion trips each team member has two bags, one personal bag and one Project Compassion bag. Should the airline allow only one free checked bag, the Project Compassion luggage is designated as the free bag. In these instances, I can choose to only use a carry-on bag to avoid being charged for a personal checked bag. * Funds submitted in excess of the minimum required contributions for each outreach will be treated as a general donation to Project Compassion will not be refunded to me. * Cancellation: If at any time I cancel my registration for a Mission Trip, all funds not already expended on my behalf may be used for another Mission Trip with Project Compassion within 12 months of cancellation. If I do not go on a Mission Trip within 12 months, the funds paid by me will be considered a general donation to Project Compassion. I understand that I will not receive a refund. * Extra Expenses: I understand that I am responsible for costs that are not covered by the cost of my trip. * I give my permission to Project Compassion to publish photos and testimonies that are appropriate and related to the Mission Trip. FULL NAME * LIABILITY RELEASE – RELEASE OF ALL CLAIMS Consent to Electronic Signatures and Documents By completing this consent form you are providing electronic consent to the use of electronic documents and signatures. Your electronic signature on any of the electronic documents, including this Application and All Consent Statements, will bind you to that document the same as if you had signed a paper copy of the document with an ink pen. You agree to not contest the validity or enforceability of any electronic document you receive or electronically sign because the document and your signature are in electronic form. You understand that you should contact us to report any problem with your application. You should retain a copy of all electronic documents we provide to you, including this Application and all Consent Statements, for your future reference. You can do this by printing the page on paper or saving it to your computer. The parties agree that this application may be electronically signed. The parties agree that the electronic signatures and initials appearing on the application are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. By selecting the “I Accept” button, you are signing this Agreement electronically. You further agree that your signature on this document (hereafter referred to as your “E-Signature”) is as valid as if you signed the document in writing. FULL NAME * Date * Time * In consideration for being accepted by Project Compassion, Inc. for participation in an event, I do hereby release, forever discharge and agree to hold harmless Project Compassion and the Directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in the above described trip or activity including work activities and recreation. FULL NAME * Date (mm/dd/yyyy) * The undersigned further consents to the administration of first aid and or doctors care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the neccessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify said organization, its directors, employees and agents from any acts of malfeasance and or failure to act on the part of those chosen to administer care on behalf of the participant. The undersigned furthermore attests and verifies that he or she is physically fit and has no medical condition(s) that would prevent him or her from performing the volunteer services for which he or she is applying. Participant Name * FULL NAME * We are excited for you to travel with Project Compassion. This waiver and agreement must be signed by all parties in order to travel locally and internationally with Project Compassion, Inc. RELEASE OF LIABILITY AND AGREEMENT NOT TO SUE, INDEMNIFICATION, HOLD HARMLESS, LIMITATION OF WARRANTY We all know that these are uncertain times. The risks of COVID-19 are not well understood and there is controversy among the experts on how the virus can spread and difficulty in scientifically determining whether anyone has the virus at any moment in time. I agree * Project Compassion, Inc. and our board members are not experts in the risk analysis of COVID-19. We are willing to move forward with local and international travel if you are willing to accept the risks of contracting COVID-19. I agree * In consideration of traveling locally and internationally with Project Compassion, by clicking I AGREE below, you agree to accept all responsibility for the risk that you may contact COVID-19. While we are taking your safety very seriously, we cannot guarantee that you will be protected from contracting COVID-19. I agree * Now therefore, in consideration of traveling locally and internationally with Project Compassion, Inc. I agree that should I contract COVID-19, I agree to indemnify and hold Project Compassion, Inc., its officers, and agents and their successors and assigns harmless from any and all claims for damages. I agree * I further agree that I will not file, nor cause to be filed, nor participate in any lawsuit against Project Compassion, Inc., its officers and agents and any other person who may be in any way connected with ALL travel sponsored by Project Compassion, Inc. for injuries and/or death as a result of contracting COVID-19. I agree * I agree that if I take any steps to make a claim for damages against Project Compassion, its Board of Directors or agents or any other released parties arising out of my travel locally and or internationally with Project Compassion, Inc. I shall be obligated to pay all attorneys’ fees and costs incurred as a result of such claim. I agree * I acknowledge that it is my choice to travel locally and or internationally with Project Compassion, Inc. I acknowledge that Project Compassion, Inc. is not the only organization or group where I can travel with locally and or internationally. By signing this Agreement, I acknowledge that I am free to travel locally or internationally with other people and organizations who may not require my agreement to accept responsibility for contracting COVID-19. I therefore chose to travel locally and internationally with Project Compassion, Inc. I agree * In addition, I agree that if any dispute or claim relating in any way to the services and arrangements provided by Project Compassion, Inc. and / or affiliates pursuant to the terms of this agreement will be resolved by binding, individual arbitration, rather than in court. I agree that arbitration shall be governed by the Federal Arbitration Act (FAA), including its procedural provisions, in all respects. I agree * At time of travel, I will state that I am NOT experiencing symptoms of the COVID-19 virus as dictated by the CDC. I am NOT living with or have been quarantined with anyone showing symptoms of the COVID-19 virus. I agree * I agree to provide proof to Project Compassion that I have received the COVID19 vaccination(s). I agree * Prior to returning to the USA you may need to present an approved negative COVID19 test. You will be financially responsible for paying for a COVID19 test. If you test positive, you are personally and financially responsible for obtaining lodging, food and ultimate return travel, including airfare to the USA. Project Compassion will not be responsible in any way for your personal arrangements should you test positive to COVID19. I agree * My entry of my first and last name below is my signature for this document. I understand that if I disagree with any statement I will not be allowed to travel locally or internationally with Project Compassion, Inc. I agree * In order for your application to the Mission Trip to Chiapas to be complete, please provide ALL of the following information through the upload link below: * File Upload
Please upload all files here.