Ministry Opportunities 2025 Colorado Springs Mission Trip Please enable JavaScript in your browser to complete this form.Name *FirstLastUnder 18 years old? *YesNoEmail *EmailConfirm EmailPlease enter a Valid Email AddressAddress *Please enter the house or Apartment Number Where you LiveCity *State *Zip Code *Cell Phone *Other Phone Number (Home or Work) Do you have any known Allergies? (Including Food Allergies) *YesNoIf Yes, list allergies here.Do you presently take any medications regularly? *YesNoIf Yes, list medications and condition here. be employees the List any other Medical ConditionsDate of last Tetanus immunizationDo you have Current Medical Insurance? *YesNoName of Insurance Company *Policy Number *Does your insurance require notification prior to Emergency Room health care at a hospital?YesNoIf Yes, Phone Number?Trip Registration FeePrice: $300.00 I, will be participating in the 2025 Associational Mission Trip sponsored by North Canadian Baptist Association. In the event I should need emergency medical care or attention, North Canadian Baptist Association and /or any one of its agents or employees is hereby authorized to consent to the provision of such emergency medical care, including, without limitation, medical, dental, surgical care or hospitalizations, as is recommended or suggested by a doctor, nurse, surgeon or other health care professional. If such emergency care is provided to me, I understand that my health insurance information will be given to the health care professional and that any expenses not covered by my insurance will be my responsibility. I understand the North Canadian Baptist Association will not be obligated to pay either the health care professional or me for any medical expenses incurred. Furthermore, in consideration of my being allowed to participate in the 2025 Associational Mission Trip I hereby waived any and all causes of action, rights, claims or suits which I may have against the North Canadian Baptist Association, its agents, or employees as a result of injury to myself or arising from the decision of North Canadian Baptist Association or its agents or employees to consent to the provision of emergency medical care. I give authority and permission to the North Canadian Baptist Association staff and agents to inspect my personal belongings while on the Mission Trip for the safety of all Mission Participants.Digital Signature of Participant (Entering Your Name here is your signature) *Enter Participant's Name as Digital SignatureIf Participant is under 18 years of age: I, give my above named (son / daughter) Permission to travel on mission to Colorado Springs, Colorado from Oklahoma with the North Canadian Baptist Association for the 2025 Mission Trip from July 19-26, 2025Enter Parent / Guardian's name as a Digital Signature Register Now
