LET'S GO!

Mission Trip #7482

Cheyenne River, South Dakota : June 23 - June 29, 2024
55 Participants - Mixed Age Group

Individual Participant Form

Before you begin...

Welcome to Next Step Ministries and thank you for signing up for a Next Step Mission Trip! We're excited for your mission trip to start, but first we need some information from you.

Please fill out this form and carefully read all the terms and conditions. Once you complete this form, you can digitally sign it below and submit it.

If you are under 18 years old, you must fill out this form with your parent or legal guardian, and then they must also digitally sign it below.

Thanks!

Personal Information

First Name(Required)

Last Name(Required)

Sex(Required)

Age(Required)

Date of Birth(Required)

Address(Required)

City(Required)

State(Required)

Zip(Required)

Emergency Contact

First Name(Required)

Last Name(Required)

Relationship(Required)

Main Phone(Required)

Alternate Phone

Medical Profile

Do You Have any Food or Medicine Allergies?

YES

ALLERGEN NOTICE

While Next Step implements precautionary measures and safeguards to help accommodate our participants with allergies, we cannot guarantee an environment completely free of airborne or other allergen presence while at the trip host location or while on the worksites or in the community. Please be sure to give as much needed detail below as you can regarding the specifics of your allergies to help us better prepare for your trip. If you have any concerns or would like to speak with someone on staff regarding the specifics of your case, please contact us at 866.534.2009.

List Any Food or Medicine Allergies(Required)

List Any Pertinent Medical Conditions

List Any Dietary Restrictions (ie. celiac disease, vegetarian, gluten free)

Have you had a tetanus shot in the past 10 years?(Required)

Yes

Date of Tetanus Immunization(Required)

Must be within the last 10 years.

If you choose not to vaccinate, please sign below.

Tetanus Waiver Signature

In consideration for Next Step Ministries allowing myself/my child to participate on their mission trip, I hereby release Next Step Ministries, its officers, trustees, agents and all other associated with it from all liability of any type whatsoever which may arise in whole or part, directly or indirectly from my decision for my child to abstain from having a tetanus inoculation as would ordinarily be required by Next Step Ministries. Further, I agree to indemnify and save and hold Next Step Ministries harmless from any claim, by whomever it may be asserted and from any expense and liability which may arise in whole or in part, directly or indirectly, from my decision for my child to abstain from having a tetanus inoculation as set forth above.

Family Physician

Family Physician Phone

Insurance is required for all trip participants. If you do not have coverage, you are expected to purchase temporary health insurance for the trip. Next Step recommends an inexpensive program called the Volunteer Card. To learn more please visit www.volunteercard.com

Insurance Company(Required)

Insurance Company Address(Required)

Insurance Company City(Required)

Insurance Company State(Required)

Insurance Company Zip(Required)

Insurance Company Phone(Required)

Policy or Group #(Required)

Subscriber Name(Required)

Subscriber Phone(Required)

Worksite Skills

We take on a variety of work projects that require a range of experience and skills. It helps us organize your work crew if we know your prior experience and comfort level when it comes to various activities.

Please rate your experience from 1 to 5 (1=No Skill; 3=Feel Comfortable; 5=High Skill).

Don't worry if you're coming on your mission trip with no experience. We have trained construction leaders who will help you every step of the way.

Painting(Required)