4
Medical & Health Information
This information is kept strictly confidential and is used solely to ensure your health and safety during the trip. Please be thorough and honest.
Do you have any known medical conditions, disabilities, or chronic illnesses?
Current medications (name and dosage)
Known allergies (medications, food, environmental)
Insurance provider and policy number (if applicable)
Doctor / Primary Care Physician
Are there any physical limitations that could affect your participation in trip activities?
Anything else the team leader should know about your health?
5
Background Check Authorization
Why We Require This
For trips involving work with minors, vulnerable populations, or ministry partners who require it, First Baptist Church of Gordon requires a background check to be completed prior to departure. This protects the people we serve, our team, and our ministry partners. Background checks are processed by a third-party provider and results are reviewed only by designated church leadership. By consenting below, you authorize FBC Gordon to conduct a background screening using the personal information provided in this application.
I authorize First Baptist Church of Gordon to conduct a background check as part of my mission trip application. I understand that the results may affect my eligibility to participate in certain trips and will be handled with confidentiality.
7
Liability Waiver & Release
Assumption of Risk
I acknowledge that participation in mission trip activities involves inherent risks, including but not limited to: travel delays or cancellations, illness, injury, exposure to infectious disease, political instability, natural disasters, accidents during transportation or physical activities, and other unforeseen hazards. I voluntarily assume all such risks associated with my participation in the mission trip sponsored by First Baptist Church of Gordon.
Release of Liability
In consideration of being permitted to participate in this mission trip, I hereby release, waive, discharge, and covenant not to sue First Baptist Church of Gordon, its pastors, staff, volunteers, ministry partners, and agents from any and all claims, demands, losses, liabilities, or expenses arising out of or related to my participation in the trip, including those caused by the negligence of released parties, to the fullest extent permitted by law.
Medical Authorization
In the event I am incapacitated or otherwise unable to consent to medical treatment, I authorize the trip leader or FBC Gordon staff to seek and approve emergency medical treatment on my behalf. I agree to bear all costs related to such treatment. I have disclosed all known medical conditions and medications in Section 4 of this form.
Code of Conduct
I agree to conduct myself in a manner consistent with the mission and values of First Baptist Church of Gordon and the teachings of Jesus Christ throughout the duration of the trip. I understand that behavior contrary to these standards may result in removal from the trip at my own expense. I agree to follow the direction of the trip leader and abide by all rules set forth for the trip.
I have read and agree to the Assumption of Risk, Release of Liability, Medical Authorization, and Code of Conduct stated above. I understand this is a legally binding agreement and I am signing voluntarily.
8
Acknowledgment & Signature
By typing your name and submitting this form, you confirm that all information provided is true and accurate to the best of your knowledge, and that you have read and agreed to all sections above.
