Project Mexico Registration, Spring 2008
First name
*
Last Name
*
Street Address
*
Address Line #2
City
*
State
*
Zip Code
*
Home Phone
*
Work/Cell Phone
E-mail Address
*
Alternate e-mail
Additional information
Please select what team you would like to be on. If you have no preference, select "ANY TEAM" and we will choose one for you!
Team:
Please select...
ANY TEAM
Beth Hanson/Kevin Shannon
Creekside Christian Fellowship (Kissel)
Saddleback (Ferruzo/Taylor)
Saddleback (Fried/Hazlett)
TerraNova Church 1
TerraNova Church 2
Troop 321 (Covey/Raus)
Church/Organization affiliation
Age
*
¿Hablas Espanol?
No
Some
Fluent
T-Shirt Style
*
Men's
Women's
T-shirt Size
*
Please select...
3X-Large
2X-Large
X-Large
Large
Medium
Small
Kid's
Tuition Fee
*
Please select...
$65 (adult)
$55 (under 14)
Payment Method
*
Please select...
Not paid yet
Check
PayPal
Cash
Enter Check #
Please make your check payable to "TerraNova Church". In the memo field, write "Project Mexico" and the name of your team (if known).
Cash payments must be made in-person to your team leader or directly to the Project Mexico office. Please do not mail cash.
Sorry for the inconvenience, Project Mexico can't accept payments via PayPal at this time. We're working to get this fixed. Thank you for your patience.
Experience
There is no experience necessary to participate in Project Mexico. However, we like to get an indication as to the level of skill and ability present.
Indicate below your areas of interest and corresponding level of skill:
Framing
Very Skilled
Somewhat Skilled
Willing to Learn
Electrical
Very Skilled
Somewhat Skilled
Willing to Learn
Roofing
Very Skilled
Somewhat Skilled
Willing to Learn
Drywall
Very Skilled
Somewhat Skilled
Willing to Learn
Trim & Finish Carpentry
Very Skilled
Somewhat Skilled
Willing to Learn
Painting
Very Skilled
Somewhat Skilled
Willing to Learn
Siding
Very Skilled
Somewhat Skilled
Willing to Learn
Can color INSIDE the lines
Very Skilled
Somewhat Skilled
Willing to Learn
Can make a killer PB&J sandwich
Very Skilled
Somewhat Skilled
Willing to Learn
Other (please describe)
Carpool Information
I plan to depart:
Friday Morning
Friday Evening
Are you willing to drive?
I plan to ride with:
Yes
No
Driver's License Number
Vehicle Make:
Vehicle Model:
VIN number:
How many seatbelts?
WAIVER OF LIABILITY
Read the following waiver. If you accept these terms, select the "I agree" button at the bottom of this section. Enter your full legal name and today's date in the spaces provided.
I recognize participation on a trip of this nature may be hazardous and dangerous. Therefore, I am, for myself, my heirs, executor and/or administrator, remise and releasing and forever discharging TerraNova Church and Baja Christian Ministries, and all its officers, agents, servants, and employees, acting officially or otherwise, from any and all reason of any injury, damage (including property damage to any of my belongings), loss or death which may occur from any cause including, but not limited to any accident and/or occurrence while participating individually or with others while on this mission trip. The undersigned, desiring to participate in the activities, programs, and ministries promoted and/or facilitated by or through TerraNova Church and Baja Christian Ministries, hereby agrees to assume any and all liability for the undersigned’s acts or missions in the course of the activity participated in by the undersigned, and further relieves TerraNova Church and Baja Christian Ministries, its officers, Board of Directors, agents, and any and all other persons associated with or operating through TerraNova Church and Baja Christian Ministries of and from any and all liability for injuries occurring in the Continental United States or outside of the Continental United States, and agrees to indemnify and hold TerraNova Church and Baja Christian Ministries, its officers, Board of Directors, and agents harmless for any and all damages or injuries which may be caused by the undersigned in the course of participating in activities sponsored, promoted, or participated in by TerraNova Church and Baja Christian Ministries. The undersigned understands that these waivers and releases herein cover each and every member of the undersigned’s family and that the undersigned’s agreement in these waivers and releases is a precondition to the undersigned’s participation in activities sponsored, promoted, or participated in by TerraNova Church and Baja Christian Ministries.
I have read and agree to this release
I agree
I do not agree
Your legal name
*
Today's date
*
Note: A signed hard-copy of the waiver form is still required. By filling-in the information above, you have reserved a spot on your team. However, the completed form is REQUIRED before departure. Click
here
for a copy of the form. Please print, sign, and mail/fax to your team leader.
Are you 18 or older?
Yes
No
Volunteers under 18 years of age must have a parent or legal guardian fill in the information below.
Parent/Guardian legal name
Today's date
Format: MM/DD/YYYY
Are you traveling with your parent or guardian?
Yes
No
If you are under 18 AND you are not traveling with your parent or guardian, then the "Letter of Consent" form must be received in order to confirm your registration. Until the form is received, this Web application is conditional upon the hard-copy forms. Click
here
for a copy of the form. Please print, sign, and mail/fax to your team leader.
Medical Disclosure
Emergency Contact:
*
Name and phone number
Allergic reaction to medicine:
Any medical needs or diet restrictions?
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