Register - 2028 Mission Group

Personal Information
Name as it appears on passport, driver's license, or birth certificate:*
First Middle Last
Date of Birth:*
Are you 18 years old or older?*
- Yes
- No
Gender:*
- Female
- Male
Home Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Secondary Phone
Email*
T-shirt size:*
- Adult Small
- Adult Medium
- Adult Large
- Adult XL
- Adult XXL
- Youth Medium
- Youth Large
- Youth XL

Medical
How would you describe your present health?*
- Good
- Average
- Poor
Are you currently under the care of a physician for a medical condition?*
- Yes
- No
If yes, what condition?
List all prescription medication you would bring on the trip (and for what conditions):
Date of last tetanus shot:
Must be within the last 10 years
List any physical disabilities, limitations or medical condition that limits or prevents you from fully participating in the trip:
List any known allergies and reactions:
List any major illnesses in the past year:
Have you fainted or passed out? When and Why?
Health Insurance Information
Company*
Group #*
Phone*
Policy #*

Testimony
Why do you want to go on this trip?
How would you describe your daily relationship with Jesus Christ?
Have you had training in personal evangelism? Please explain.
Briefly describe how you see God calling you to participate on this trip.
What are your talents and how do you see them being used on this trip?
Church you currently attend:
Participation Agreement
Your signature below indicates that the participant acknowledges and agrees to faithfully attend all training meetings at their scheduled times, as they are critical for the physical preparedness and spiritual unity of the entire team. The participant also acknowledges there is a non-refundable $100.00 deposit due with the submission of this form. The total amount is due in full by April 30th.
Participant's Name*
Participant's Signature*
Date*
Parent/Guardian Signature if participant is a minor:*
Parent/Guardian Name if participant is a minor:*
Date*

Permission & Liability - Minors
I,
Guardian Name*
on behalf of
Participant Name*
or whom I am legally responsible, accept the conditions and risks outlined in this release and consent to their participation as a participant on a mission trip sponsored by 20:28 Mission Group to Represent and agree that:
Trip Destination
1. I am legally responsible for the above identified minor (participant) 2. I am aware of the potential hazards and risks to the participant and property associated with serving in a missions capacity, such hazards and risks including, but not being limited to, injury or death by accident, disease, war, terrorist acts, weather conditions, inadequate medical services and supplies (in remote locations), criminal activity, and random acts of violence. I accept these risks recognizing that 20:28 Mission Group would not be able to offer the opportunity for missions service without a release such as this. With respect to 20:28 Mission Group and its agents, volunteers, officers, directors, and employees, I assume all risks of death, injury, and illness associated with such risks on behalf of the participant, and any damage to their personal property, and I release 20:28 Mission Group and its agents, officers, directors, and employees from any liability that the participant may suffer as a result of participation in the mission project. I further acknowledge that such risks have always been associated with missionary service. (2 Corinthians 11:23-28) 3. I attest and certify that the participant has no known medical conditions that would prevent them from participating. 4. I give permission for my child to be photographed, and/or recorded, with video and/or sound, for promoting 20:28 Mission Group and its activities, and/or for creating an audio or video product of the trip for sale. 5. I understand that my child is going on this trip at least in part for the spiritual blessings of serving as God asks. 6. I further understand that 20:28 Mission Group does not have or offer any insurance coverage that would apply in the event of illness, injury or death, or damage to property that may occur during participation on the trip, and that if I desire insurance coverage I am responsible for the cost of arrangements for such insurance. I understand that travel insurance may or may not be provided for the trip, and it is my responsibility to find out if travel insurance is provided. 7. I expressly agree that this assumption of risk agreement is intended to be as broad and inclusive as permitted by law. I further state that I have carefully read foregoing assumption of risk and understand its contents, and I voluntarily sign this release as my own free act. I also understand that this is a legal document and I have the right to consult with an attorney before signing it.
Parent/Guardian Signature*
Parent/Guardian Name*
Date*

Medical Release - Minors
For Completion by the parents of all participants under the age of 18
Parent/Guardian Name*
First Last
Parent Home Phone
Parent Work Phone
Parent Cell Phone*
Emergency Contact other than parent(s)*
First Last
Relationship:*
Daytime Phone*
Evening Phone
In an emergency, illness, injury, or accident which requires medical attention, I give my permission to 20:28 Mission Group, its representatives and all attending health care professional (defined as including, but not limited to registered nurses, licensed practicing nurses, physician’s assistants, doctors and paramedics) for my child, to receive medical treatment, to hospitalize, anesthetize, or perform surgery. I understand that every effort will be made to contact me before these actions are taken. I, , the undersigned, do release, acquit, discharge and covenant to hold harmless 20:28 Mission Group, and its representatives from all actions, damages or liabilities arising out of the treatment of an illness, injury, or accident incurred during my child’s participation on the trip. It is the intention of this release that 20:28 Mission Group and its representatives incur no liability whatsoever while attempting to meet all medical needs that my child may require during the project.
Parent/Guardian Signature*
Date*

2028 Missions Group Account Creation
Name of Account Owner*
First Last
Account Email*
Enter Email Confirm Email
Username*
Password*
Enter Password Confirm Password

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Short-Term Mission Projects Policies
Financial Policy for short-term team members: Team members are expected to raise 100% of their financial support for the trip. Funding will be completed by the due date set by the team leadership. Policies for Team Behavior and Attitude: Team members participating on 20:28 Mission Group sponsored short-term trips are reminded that they are ambassadors of Jesus Christ (2 Corinthians 5:20). As teams goes to the mission field, they not only represent Christ but also 20:28 Mission Group, our Pastor, the United States and the supporting mission agency. This is a tremendous responsibility. For this reason, 20:28 Mission Group asks that each team member seek to be above reproach in his/her actions and attitudes. Team members must submit to the team leader’s authority. Due to the political instability and anti-American sentiment in various countries around the world, 20:28 Mission Group asks that team members refrain from expressing political opinions while on a Mission Trip. All team members must abstain from the consumption of alcoholic beverages or any use of illegal drugs. The team member must adhere to the behavioral guidelines for each specific team set by the team leadership or missionary agency with a mind toward the culture to which the team is going. This will require a servant attitude toward all nationals and team members, as will as the willingness to learn from the host culture (1 Corinthians 9:19-23a) The team leader reserves the right to ask a problem team member to return home if that team member’s behavior is disruptive/destructive to the team, the ministry, or the host community. Any additional cost incurred as a result of this action will be at the team member’s expense.
Consent
I have read and understand the policies outlined above, and I agree to abide by these policies.
Participant Signature
Parent/Guardian Signature
If under 18
Date

Payment Information
How Do You Want To Pay?*
NonRefundable Deposit*
Price:
Total
$0.00

Appalachia Mission Trip Registration

Personal Information

Skills

Medical

Health Insurance Information

Testimony

Participation Agreement

Permission & Liability - Minors

Medical Release - Minors

2028 Missions Group Account Creation

Short-Term Mission Projects Policies

Payment Information