Permission: All Participants
Permission Slip,
 Emergency Information
& Parental Consent

Complete and mail to: People Building People
P.O. Box 1083
West Chester, OH 45071-1083

Part A - To be completed if participant is an adult

I, __________________________, will be going on the Mexico Mission Trip with People Building People from __________________ to __________________, 2______ (dates of trip).

Part B - To be completed by parent or legal guardian if participant is a minor (under age of 18)

I give permission for my minor child, _____________________ (name of child), to go on the Mexico Mission Trip with People Building People from ___________________ to _________________, 2______ (dates of trip).

Part C - To be completed by everyone

I fully understand that participation in this mission trip may result in illness, accident or injury. I have been afforded every opportunity to conduct my own investigation of the conditions surrounding this trip and certify that participation in the trip is a matter of free choice. I am specifically aware that certain hazards and risks are associated with serving in a mission capacity, including but not limited to death or injury by accident, disease, war, terrorist acts, adverse weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence or negligence. On behalf of the participant, I hereby assume these risks and release in full any claims of any type against People Building People and its officers, directors, agents, and employees. I can be reached at the following telephone numbers during the day _____________________ (phone number) or evening ___________________ (phone number). Should it be necessary for the participant to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The participant has the following allergies, medical conditions, or other special concerns of which People Building People should be aware:
__________________________________________________________
__________________________________________________________
__________________________________________________________

Part D - To be completed by everyone

We (I) authorize People Building People or any adult on this trip in whose care the participant has been entrusted to consent to any medical examination or treatment, including hospital care, to be rendered to the participant by a duly licensed physician or dentist. We (I) agree to be liable for all expenses incurred in connection with such medical and dental services rendered to the participant pursuant to this authorization.

Insurance Co. ______________________ Policy #: _______________
Address: _____________________ City: _____________ State: ___
Hospital Insurance: _____ Yes ______ No
Emergency Numbers
Doctor: ____________________________ Phone #: _________________
Other: __________________ Relationship: ________ Phone #: _________

Signatures

___________________________Date:____________
Signature of Adult Participant

___________________________Date:______________
Signature of Parent/Guardian** (#1)

___________________________Date:______________
Signature of Parent/Guardian** (#2)

______________________________ Date:_______________
Notary** (Required if participant is under age 18 with no parent/guardian on trip)

** This needs to signed by both parents or guardians and notarized if both parents are not on the trip for youth under 18 years of age.

Covenant: All Participants
Mexico Covenant
Sign and mail to: People Building People
P.O. Box 1083
West Chester, OH 45071-1083

As a member of the Mexico Mission Team, I promise to obey the following rules for this trip.

  • I will sleep in designated areas for guys only or ladies only.
  • I will refrain from using or buying any tobacco product(s), drugs, or alcoholic beverages at any time on this trip. Non-prescription and prescription medications need to have use verified by a parent or guardian on our permission slip form along with a description of how and when the medication is to be taken. I understand if someone is suspected of having any of these items, an adult on the trip will check bags.
  • No guys and ladies will be permitted in hotel rooms without an adult present.
  • I will use only good language in the presence of my teammates.
  • No sleeveless or strapless shirts will be worn. No short shorts will be worn.
  • I will have a positive and an "I will help" attitude at all times and when asked to help.
  • I will respect the property of others, including any facilities being used. I understand any damage that I make, I and/or my parents or my guardian may be held responsible for repairs or replacement.
  • I will remain as a part of the group and participate in all planned activities. I will not leave the designated areas. I will be on time to all gatherings.

I agree to respect the authority of the leaders.

I fully understand and will obey these rules on this trip. I know failure to comply with these rules will bar me from ever attending another Mexican Mission Trip.

I acknowledge the purpose of this trip is to honor Jesus Christ by:

  • Ministering to our neighbors in Mexico.
  • Building up and encouraging other ministry team members.
  • I promise to support the primary purpose to the best of my ability.

_____________________________________________________
Participant Signature / Date

_____________________________________________________
Parent(s) or Guardian Signature / Date (If participant is under 18)

Drivers: Age 25 and older
Drivers Acknowledgement and Authorization
Sign and mail to: People Building People
P.O. Box 1083
West Chester, OH 45071-1083

DRIVER ACKNOWLEDGMENT / AUTHORIZATION
AND
DISCLOSURE UNDER FAIR CREDIT REPORTING ACT
AND
CONSENT TO PROCUREMENT OF CONSUMER REPORT


The undersigned hereby authorizes People Building People Non-Profit Organization or its insurance agency, Bauer Insurance Agency, Inc., or its/their assigns, to obtain copies of consumer reports, including motor vehicle driving report, pertaining to me. And, for use in insurance rating and/or underwriting insurance decisions for which the above-named organizationsí insurance policy may apply, and any renewal or rewrite of coverageís thereof. I understand that in obtaining such consumer reports, a consumer reporting agency may be used, and I do hereby authorize such use. I also understand that any adverse information may create a problem in my being covered on the above-named organizationís insurance policy.

By volunteering to be a driver/operator of a vehicle for People Building People Organization, I also acknowledge and recognize with my signature below, the following:

  • That my driverís license is active and valid.
     
  • That I have no restrictions, physical or health conditions which impair my ability to safely drive/operate a vehicle.
     
  • That I will endeavor to require all passengers in the vehicle (including myself) to be properly restrained by buckled seat belts at all times.
     
  • That I will endeavor to maintain an alert and active Co-Pilot (front passenger seat) to assist me in navigation, defensive driving and to stay on alert for potential road or driving perils or hazards.
     
  • That I will obey and honor all posted speed limits and all traffic signs.
     
  • That I understand there are inherent liability risks to me personally, anytime I drive/operate any vehicle; and that these liability risks, to me personally, are accepted and understood. In order to properly protect myself I understand that I need to review my personal auto insurance policy liability limits of coverage with my personal insurance agent/advisor and upgrade those coverage limits as I deem necessary. I understand that, at minimal, it is recommended that I carry a personal umbrella insurance policy (Excess Liability Insurance) at protection limits of my choosing and selection.

Signed:___________________________________________________________
Date:_____________________________________________________________
Print Name of Signature Above:__________________________________
Social Security #:_________________ Date of Birth:________________
State Licensed:____________________ License #:____________________