SHSM & AIM Rocky Point Mexico Mission Trip - December 9-11, 2022

Student Name

Student Email

Student Phone

Parent(s) Name(s)

Parent's Phone

Parent's Email

This address will receive a confirmation email

Address

Additional Emergency Contact (name and phone number)

Payment

Understanding that the appropriate measures will be taken to contact me and the emergency contact, as parent named above, I/We give our consent to the adult leaders of this trip to provide any necessary decisions regarding the above student's health and/or life. I/We also give consent to any licensed medical professional to take appropriate measures to preserve the health and/or life of the above named student.

Yes No

On behalf of the named participant, I agree to hold harmless Shiloh Community Church and the leaders of this trip for any liability sustained due to the participant's negligence (intentional or unintentional), including expenses incurred as a result. I agree to reimburse Shiloh Community Church, and/or the leaders of this trip any financial expenses incurred due to the participant's negligence (intentional or unintentional).

Yes No

On behalf of the name participant, I agree to give Shiloh Community Church and the leaders of this trip the right to use the participant's name (or functional name), picture, portrait, or photograph in all forms and media in all manners, including composite or distorted representations, for advertising, trade, or any other lawful purposes, and I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection with this activity.

Yes No

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Our SHSM will be heading to Rocky Point, Mexico on December 9-11 to help A.I.M. missions provide Christmas gifts, food, encouragement, and the Gospel with local families.

We will leave the church at 7am on Friday, December 9 and return approximately 2pm on Sunday, December 11.

We will be staying together in a large, secure, 5-bedroom house on the beach. In addition to the local outreach events in the community, we will be spending time encouraging each other in our faith.

Cost is $60/person, which covers lodging, food in Mexico, and transportation. Additional money is needed for snacks/food on the road. See Pastor Kevin for list of items to bring (and not bring).

Registration due by November 16.

SHSM & AIM Rocky Point Mexico Mission Trip - December 9-11, 2022

Description

Please Fix the Following