Missions on-line registration form
A non-refundable deposit of $150.00 is required per person for all trips except Mission Navajo. The non-refundable deposit for Mission Navajo is $170.00 per person.
Make checks payable to Lutheran Church of Hope with the trip name in the memo and turn in to the front office.
When submitting your registration, please provide a copy of your insurance card (front & back). For international travel, you must also provide a copy of your passport (and Visa for Mission Ghana).
To register a family, complete only one registration form and list all names and birth dates of those registering in the box requesting this information.
Type names EXACTLY as they appear on your travel documents (passport, Visa, etc).
* Required
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Emergency Contact Information
Please indicate any areas in which you are proficient
Health Information
Please complete for Mission Ghana, Mission Jamaica, Mission South Africa, Mission Uganda or Mission Umzimvubu
Please complete this section for Mission Ghana only
Indicate T-shirt size
In the event of an emergency or non-emergency situation in which medical treatment is required as a result of participation with Lutheran Church of Hope, every reasonable effort will be made to contact the person(s) listed on this form. If unsuccessful in contacting the person(s) listed, consent/permission is given for treatment by competent medical personnel.
Further, unless specified otherwise, consent/permission is hereby given to all accompanying adult volunteer leaders on the trip to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery (under recommendation of qualified medical personnel). If possible, the adult contact person for your group should make the final decisions in cooperation with medical personnel.
I understand that Lutheran Church of Hope does not carry accident or medical insurance on participating volunteers. I agree that my insurance company will be used for such medical care expenses and I am aware that I may be billed by the medical provider for any medical treatment expenses not covered by my insurance. I understand that if I do not have medical insurance coverage that I am responsible for the payment of any medical bills.
Last Published: March 15, 2010 11:41 AM