Personal Information Check this box if you are a group leader.
Emergency Contact
Medical Profile Do You Have any Food or Medicine Allergies? List Any Food or Medicine Allergies (Required)
Do You Have any Pertinent Medical Conditions? List Any Pertinent Medical Conditions (Required)
Do You Have Any Dietary Restrictions? (ie. celiac disease, vegetarian, gluten free) List Any Dietary Restrictions (ie. celiac disease, vegetarian, gluten free) (Required)
Have you had a tetanus shot in the past 10 years? (Required)
Worksite Skills
Participant Authorizations and Releases
Publicity Release (Parental guardian signature required for children under 18 years of age.)
Before you (or your child under 18 years of age) participates in our Mission Trip, we need your permission to use your or your child’s image and likeness in Next Step Ministries’ promotional material. Next Step Ministries will not use you or your child’s last name, street or mailing address, e-mail address, or phone number in connection with its use of you or your child’s likeness.
When requested on-site, we will do our best to avoid any images or video of specific individuals, but please be aware that with cameras in everyone's hands, we cannot guarantee that specific requested people will not unintentionally be visible in any images we take and/or are ultimately sent by others for usage or sharing.
Please read the following statement carefully, ask Next Step Ministries’ staff to clarify any questions you may have, and sign and fill below when you understand.
In consideration of my or my child’s participation in the Mission Trip:
I give permission to Next Step Ministries to use and distribute my or my child’s image or likeness in the form of a photograph, short video, and/or voice recording that depicts my
or my child’s participation in the Mission Trip (“Depictions”). Next Step Ministries may use the Depictions for advertising, promotion, and other commercial and business purposes. Allowable use includes copying, distribution, and display on the Internet (including Next Step Ministries’ websites and social media sites).
I acknowledge that there is no compensation for granting this permission or for Next Step Ministries’ future use of the Depictions.
By signing this statement, I understand that I am releasing, waiving, and discharging Next Step Ministries from all claims of any kind or nature arising from or related to Next Step Ministries’ use of the Depictions, except for claims for damages caused by Next Step Ministries’ recklessness or gross negligence.
For parental guardians of children under 18 years of age only:
I certify that I am the parent/guardian of the child mentioned below, and I consent to the above statements on his/her behalf.
I acknowledge that I have read this Publicity Release and have been given reasonable opportunity to discuss this with Next Step Ministries, and, if I so choose, my lawyer. Further, I acknowledge that I fully understand the terms of this Publicity Release, and that I have signed it freely and voluntarily.
