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Trip Application
Trip Application
Introduction
Name
Use your current legal name as it appears on your passport/birth certificate/driver’s license.
First
Middle
Last
Name you go by
Trip which you are applying?
Personal Information
Mailing Address
Street Address
Address Line 2
City
State
Zip
Primary Phone
Email
How seasoned are you?
9th grade
10th grade
11th grade
12th grade
Adult
Overseasoned
Other
*If Other, please explain.
Emergency Contact Information
Name of Emergency Contact
Relationship to Emergency Contact
Phone Number of Emergency Contact
Church Information
Name of church where you are a member.
Address
City
State
Describe your current church involvement.
Prior Mission Trip Experience
Have you been on a mission trip before?
Yes
No
If yes, please briefly fill in below
Why do you want to join us on a mission trip?
What is a goal you would like to achieve on this trip or how do you hope to grow in your faith on this trip?
Which role are you most comfortable in: Speaker, Encourager, Servant, Student, Prayer Warrior, or Evangelist?
Which role would you like to grow in: Speaker, Encourager, Servant, Student, Prayer Warrior, or Evangelist?
If yes, please pick one trip and tell us your favorite story
Faith Journey Questions
Can you share your testimony?
Have you ever shared your faith with someone?
Have you been baptized and if so - when where?
Other Questions
I understand and agree that joining a trip with TBM requires team unity and will commit to attend the majority of team meetings (in person or on zoom)
Yes
No
Many trips require ample walking, climbing, carrying, long and emotional workdays, use of weird “bathrooms”, long hours in a car-airplane-bus, frequent travel delays, occasional airport sleeping, or just lack of sleeping. Do you have any limitations that could potentially hinder your trip?*
Yes
No
Perhaps, I would like to talk to someone
Do you understand and agree with The Bucket Ministry ZERO USE policy for alcohol and tobacco while on the trip?
Yes
No
I'd like to talk with someone
References
Name
First
Last
Time known
Contact email or phone
Revelant Notes
Photo and Video Permission
Photo and Video Permission
Please check the statement below if you agree.
My Permission is granted for The Bucket Ministry to videotape or photograph myself, my child or young person during church The Bucket Ministry events or normal activities. I understand these photos or videos may be used as The Bucket Ministry promotional materials.
Trip Waiver
Participant's Name
First
Last
Date
MM slash DD slash YYYY
Participant's Parent or Legal Guardian
(If Participant is under 18 years)
First
Last
The above-referenced participant and undersigned (the
"
Participant
"
) desire(s) to participate in one or more activities, attend one or more events or otherwise be a part of one or more functions or programs, including, without limitation, camps, retreats, missions or missionary projects within the United States or abroad (collectively, the
"
Programs
"
) related to, supported or sponsored by, or otherwise associated or affiliated with The Bucket Ministry (collectively the
"
TBM
"
). The Participant voluntarily enters into this Waiver, Release and Indemnity Agreement (this
"
Release Agreement
"
) to induce TBM to allow the Participant to participate in any such Programs. Participant acknowledges that participation in such Programs will benefit Participant and that as much Participant has received valuable consideration for the execution of this Release Agreement. Based on the foregoing, Participant hereby agrees with TBM as follows:
Participant voluntarily elects to participate and engage in the Programs, knowing and understanding that: participation in the Programs may entail risk of personal injury or death to the Participant; any list or description of inherent risks of the Programs is not complete; and other unknown or anticipated inherent risks may result in personal injury, death, and/or property damage. With knowledge of the foregoing, and as an inducement for TBM to permit the Participant to participate in the Programs,
PARTICIPANT AND HIS OR HER FAMILY, AND IN THE CASE OF A MINOR, SUCH PARTICIPANT'S PARENTS, VOLUNTARILY AGREE TO ASSUME AND ACCEPT FULL RESPONSIBILITY FOR ANY AND ALL RISKS AND DANGERS OF DEATH, PERSONAL INJURY, AND PROPERTY DAMAGE ARISING FROM THE PROGRAMS, INCLUDING, BUT NOT LIMITED TO, ALL RISKS AND DANGERS ASSOCIATED WITH THE INHERENT RISKS, WHETHER DESCRIBED HEREIN OR NOT AND WHETHER KNOWN OR UNKNOWN.
Participant, and his or her heirs, executors, administrators, agents, representatives, insurers, and attorneys, hereby release and forever discharge TBM and all TBM Related Parties (as hereinafter defined) from any and all claims, suits, rights, interests, demands, actions, causes of action, obligations, liabilities, accident, injury (including death), costs, fees (including reasonable attorney's fees), expenses and any and all other damages or losses of any kind whatsoever, whether to person or property (collectively, the
"
Claims
"
) arising out of, incidental to, associated with, or in any way related to: (i) the TBM; (ii) TBM Related Parties; (iii) participation in the Programs; (iv) any acts or events in any way related to the Programs (by way of example only, travel to/from the Programs, whether in the United States or abroad); or (v) any accident, injury or death to Participant, or anyone else.
WITHOUT LIMITATION OF THE FOREGOING, THE UNDERSIGNED HEREBY SPECIFICALLY RELEASES AND FOREVER DISCHARGES TBM AND ALL TBM RELATED PARTIES FROM ANY AND ALL CLAIMS (AS DEFINED HEREIN) ARISING DIRECTLY OR INDIRECTLY FROM OR AS A RESULT OF THE NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR WILLFUL MISCONDUCT) OF TBM OR ANY TBM RELATED PARTIES
.
As used herein, the term
"
TBM Related Parties
"
shall mean and include TBM and all of the corporations, partnerships, trusts, churches, children's homes, orphanages, missions, and other entities or enterprises whatsoever affiliated or supported by TBM, and TBM's and all such other entities' respective pastors, trustees, officers, directors, deacons, elders, boards, mission or ministry team, leaders, volunteers, guests, invitees, members, employees, staff, workers, contractors, vendors, agents, attorneys, advisors, representatives and any other individual involved with the TBM in connection with Programs.
PARTICIPANT, AND IN THE CASE OF A MINOR SUCH PARTICIPANT'S PARENTS, ON THEIR OWN BEHALF, AND ON BEHALF OF THEIR RESPECTIVE HEIRS, EXECUTORS, ADMINISTRATORS, AGENTS, REPRESENTATIVES, AND INSURERS, HEREBY AGREE TO IDEMNIFY, DEFEND AND HOLD HARMLESS THE TBM AND ALL TBM RELATED PARTIES FROM AND AGAINST ANY ALL CLAIMS (AS DEFINED HEREIN) ASSERTED BY PARTICIPANT, ANY PERSON OR ENTITY RELATED TO PARTICIPANT OR ASSERTING A CLAIM BY OR THROUGH PARTICIPANT, OR ANY OTHER THIRD PARTIES OR ENTITIES WHICH IN ANY WAY, ARISE OUT OF, ARE INCIDENTAL TO, ASSOCIATED WITH, OR IN ANY WAY RELATED TO: (I) THE TBM; (II) THE TBM RELATED PARTIES; (III) PARTICIPATION IN THE PROGRAMS; (IV) ANY ACTS OR EVENTS IN ANY WAY RELATED TO THE PROGRAMS; OR (V) ANY ACCIDENTS, INJURY OR DEATH TO PARTICIPANT OR ANYONE ELSE. WITHOUT LIMITATION OF THE FOREGOING, THE UNDERSIGNED HEREBY SPECIFICALLY INDEMNIFIES, DEFENDS AND HOLDS HARMLESS THE TBM AND ALL TBM RELATED PARTIES FROM ANY AND ALL CLAIMS (AS DEFINED HEREIN) ARISING DIRECTLY OR INDIRECTLY FROM OR AS A RESULT OF THE NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR WILLFUL MISCONDUCT) OF TBM OR TBM RELATED PARTIES.
Participant, and in the case of a minor, such Participant's parents, on their behalf and on behalf of their respected heirs, executors, administrators, agents, representatives, insurers and attorneys, hereby waive their rights to sue or to bring any action against the TBM Related Parties in connection with any and all claims, liability, suits, actions, costs, attorney's fees, damages, and loss, including those arising out of death, personal injury or property damage, regardless of the cause and
WHETHER OR NOT RESULTING FROM THE SOLE OR CONCURRENT NEGLIGENCE, GROSS NEGLIGENCE, MISCONDUCT OR OMISSION BY THE TBM RELATED PARTIES OR ANY OTHER PERSON
, arising out of, relating to, or in any way connected with: (i) the TBM; (ii) the TBM Related Parties; (iii) participation in the Programs; (iv) any acts or events in any way related to the Programs, or (v) any accidents, injury or death to Participant or anyone else.
The invalidity or unenforceability of any particular provision of this Release Agreement shall not affect any other provision hereof, and in the event any provision hereof, is found by property authority to be invalid or enforceable, the Release Agreement shall be construed in all respects as if such invalid or enforceable provision had never comprised a part hereof and the remaining provisions hereof shall remain in full force and effect and shall not be affected by the invalid or unenforceable provision or by its severance herefrom. Furthermore, in lieu of such invalid or enforceable provision, there shall be added automatically hereto and as a part hereof a provision as similar in terms and intent to such invalid or enforceable provision as may be possible and be legal, valid and enforceable.
It is Participant's express intent that the TBM or TBM Related Parties shall never have any liability, damage or expense arising out of any Claim in any way associated with or relating to participation in the Programs.
This Agreement is made and entered into in the State of Texas. This Agreement shall be construed in accordance with, and governed by, the laws of the State of Texas and of the United States. The venue for any action arising out of this Agreement shall be in Rockwall County, Texas.
This Release Agreement shall continue in full force and effect until revoked, in writing, by Participant and delivered to TBM at PO Box 238 Fate, Texas 75132, and may be relied upon by TBM and all TBM Related Parties with respect to any participation in any Programs regardless of when offered.
This Agreement is made and entered into the State of Texas. This Agreement shall be construed in accordance with, and governed by, the laws of the State of Texas and the United States. The venue for any action arising out of this Agreement shall be in Fate, Texas.
This Release Agreement shall continue in full force and effect until revoked, in writing, by Participant and delivered to TBM at PO Box 238 Fate, Texas 75132, and may be relied upon by TBM and all TBM Related Parties with respect to any participation in any Programs regardless of when offered. Participant expressly waives the right to sign separate Release Agreements for separate Programs and represents that this Release Agreement shall govern all Programs. Participant hereby gives permission to have photographic and/or video images of Participant taken and/or obtained as part of the Programs and used for any media purpose whatsoever, including without limitation, advertising, promotion, marketing and packaging for any Program, product or service of the TBM and may be combined with other images, text and graphics, and cropped, altered or modified in the TBM's sole discretion.
I, the Participant named herein, am eighteen (18) years of age or older and competent to sign this Release Agreement (or, if the Participant is not 18 years old or older, I am the parent or legal guardian of Participant and agree to and sign this Release Agreement on behalf of Participant). This Release Agreement is binding and me and my spouse, family, executor, administrators and heirs. This Release Agreement shall apply to any and all Programs present or future) in which Participant participates or will participate, and in the event of any inconsistency or ambiguity between this Release Agreement and any earlier release form signed by Participant, this Release Agreement shall control.
I AM AWARE THAT TRAVEL, INCLUDING, WITHOUT LIMITATION, TRAVEL TO AND FROM ANY PROGRAMS OR TRAVEL ABROAD, HAS INHERENT DANGERS THAT POSE A RISK OF HARM OR INJURY, INCLUDING, BUT NOT LIMITED TO, DISEASE, LACK OF PROPER HEALTHCARE, CRIME, CIVIL UNREST, TERRORISM, LACK OF PROPER HEALTH STANDARDS, AND LACK OF SECURITY, AND I VOLUNTARILY CHOOSE TO ASSUME THESE RISKS. I AM AWARE THAT I MAY SUFFER BODILY INJURY, DEATH, OR PROPERTY DAMAGE ARISING OUT OF MY PARTICIPATION IN THE PROGRAMS. HOWEVER, I VOLUNTARILY CHOOSE TO ASSUME THESE RISKS AND PARTICIPATE IN SUCH PROGRAMS OR EVENTS.
I HAVE FULLY READ THE ABOVE AND UNDERSTAND IT AND HEREBY CONSENT TO IT AND AGREE TO BE BOUND BY IT.
Date of Birth
MM slash DD slash YYYY
By signing below you are signifying you have thoroughly read all information presented and all information is accurate, to the best of your knowledge. You are also signing to accept to trip waiver document as presented.
Digital Signature of Participant
(If 18 years or older)
Digital Signature of Participant's Parent/Legal Guardian
(If younger than 18 years)
Today's Date
MM slash DD slash YYYY
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