Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
*
(###)
###
####
Email
*
Date of Birth
*
MM
DD
YYYY
Nationality
*
Gender
*
Profession
*
Marital Status
*
Languages Spoken
*
Medical Conditions
*
Allergies, Dietary Restrictions, etc.
Church Membership
*
Will you need housing during the mission trip?
*
Other Information
Anything that we need to know about you
Availability
*
Are you available to volunteer the entire trip? If not, which days are you able to join us?
Interests
*
Tell us in which areas you are interested in volunteering:
Special Skills or Qualifications
*
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
Previous Volunteer Experience
*
Summarize your previous volunteer experience.
Emergency Contact
*
First Name
Last Name
Address of Emergency Contact
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number of Emergency Contact
*
(###)
###
####
Email of Emergency Contact
*
Release of Liability
*
Volunteer acknowledges that attendance at the Event and participation in the Activities are entirely voluntary. Volunteer recognizes and is fully aware that participation in the Event or Activities may involve risks of injury. Volunteer is fully aware of, understands and voluntarily accepts these risks and agrees that neither BRI nor any of its employees, owners, officers, directors, partners, agents, successors or assigns shall be liable for any injuries (including, but not limited to, bodily injury, mental injury, or death), property loss, economic loss or any other damage (hereinafter “Damage”) resulting from any act or omissions in connection with Volunteer’s attendance at the Event or participation in the Activities, including the active or passive negligence of BRI, its employees, owners, officers, directors, shareholders, partners, agents, successors or assigns. Volunteer, on behalf of himself/herself and his/her agents, representatives, spouse and heirs does hereby forever release and discharge BRI, its employees, owners, officers, directors, partners, agents, successors and assigns from all claims, demands, liabilities, injuries, damages, actions or causes of action, including Damage resulting from any acts or omissions, including the active or passive negligence, of BRI in connection with Volunteer’s attendance at the Event, or participation in the Activities. Volunteer agrees to indemnify, defend and hold harmless, BRI, its employees, owners, officers, directors, agents, successors and assigns, from all claims, demands, liabilities, injuries, damages, actions, or causes of action, arising out of or relating in any way to Damage, resulting from any acts or omissions, including the active or passive negligence of BRI, its employees, owners, officers, directors, partners, agents, successors or assigns, in connection with Volunteer’s attendance at the Event, or participation in the Activities.
Date
*
MM
DD
YYYY
