LET'S GO!Mission Trip #13466 Cheyenne River, South Dakota : June 22 - June 28, 2025 60 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 InformationFirst Name(Required)Last Name(Required)Sex(Required)Age(Required)Date of Birth(Required)Address(Required)City(Required)State(Required)Zip(Required)Phone(Required)Emergency ContactFirst Name(Required)Last Name(Required)Relationship(Required)Main Phone(Required)Alternate PhoneEmail Medical ProfileDo You Have any Food or Medicine Allergies? YES NO ALLERGEN NOTICEWhile 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 ConditionsList Any Dietary Restrictions (ie. celiac disease, vegetarian, gluten free)Have you had a tetanus shot in the past 10 years?(Required) Yes No Date of Tetanus Immunization(Required) MM slash DD slash YYYY Must be within the last 10 years.If you choose not to vaccinate, please sign below.Tetanus Waiver SignatureIn 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 PhysicianFamily Physician PhoneInsurance 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.comInsurance 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 SkillsSkill Level Survey 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=Professional or Equivalent). 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)Please enter a number from 1 to 5.Using Basic Tools(Required)Please enter a number from 1 to 5.Using Power Tools(Required)Please enter a number from 1 to 5.Using a Ladder(Required)Please enter a number from 1 to 5.Roofing(Required)Please enter a number from 1 to 5.Carpentry Skills(Required)Please enter a number from 1 to 5.Advanced Carpentry Skills(Required)Please enter a number from 1 to 5.Concrete(Required)Please enter a number from 1 to 5.Electric(Required)Please enter a number from 1 to 5.Plumbing(Required)Please enter a number from 1 to 5.Participant Authorizations and ReleasesParticipant ResponsibilitiesWhile serving on a Next Step Ministries Mission Trip, I will seek to demonstrate my love for Christ and for others by agreeing to the following:I agree not to use tobacco products, alcoholic beverages or illegal drugs.I agree not to engage in or promote the use of obscene language, dangerous behavior, or sexual, illicit or illegal activity.I agree not to have possession of or use any fireworks, firearms, knives or other dangerous items. I agree to abide by the Next Step Ministries dress code.I understand that any schedule changes must be made by or approved by Next Step Ministries Staff. In consideration of others and in order to receive sufficient rest, I will respect the lights out time each night.I agree to stay with the group at all times.I agree not to go into the room of the opposite sex.I understand that others' possessions must not be tampered with or taken. I will do my best to keep all areas of the lodging facility clean.I am excited to serve the Lord through a week of service.Participant Responsibilities Signature(Required)By typing in your name, you agree to these Participant Responsibilities.Authorization for Medical Treatment(Parental guardian signature required for children under 18 years of age.)I, the undersigned, do for myself (or for and on behalf of my child under 18 years of age) give permission for an attending physician or hospital to administer medical care if deemed necessary by Next Step Ministries' employees or the physician or hospital staff during the Next Step Ministries Mission Trip. I understand and agree that I am solely responsible for all costs related to such medical treatment and any related medical transportation and/or evacuation. I will not bring legal actions against Next Step Ministries for any claim based on such costs, transportation, evacuations, treatments, or medical services.Participant Responsibilities Signature(Required)By typing in your name, you agree to this Authorization for Medical Treatment.Parent Signature(Required)By typing in your name, you agree to this Authorization for Medical Treatment.Release of Liability(Parental guardian signature required for children under 18 years of age.)Before you (or your child under 18 years of age) can participate in our Mission Trip, we need to make sure that you understand and accept the risk of injury involved. Please read the following statement carefully, ask Next Step Ministries staff to clarify any questions you have, and sign and fill below when you understand and agree.I, the undersigned, do for myself or for and on behalf of my child under 18 years of age hereby affirm that:I understand that participating in the Mission Trip involves risk of injury stemming from inherently dangerous activities such as the use of power tools, working on construction sites, and outdoor adventure activities such as kayaking, hiking, swimming, caving, and snorkeling. Foreseeable injuries could include but are not limited to cuts, sprains, strains, broken bones, contusions, concussions, drowning, and death. I hereby assume all risks inherent in my or my child’s participation in the Mission Trip.I hereby release Next Step Ministries and those who work for Next Step Ministries as employees, contractors, directors, officers, volunteers, or partners (together, the “Releasees”) from liability for personal injury, death, property damage, and expenses that I or my child suffers as a result of participating in the Mission Trip, except for personal injury or death caused by the Releasees’ recklessness or gross negligence.I acknowledge and accept that I may be required to reimburse the Releasees for all losses, damages, and expenses that they incur as a result of my or my child’s participation in the Mission Trip, except for those incurred as a result of the Releasees’ recklessness or gross negligence.Should it be necessary for me or my child to return home due to disciplinary action, medical reasons or otherwise, I hereby assume responsibility for all transportation costs.For parental guardians of children under 18 years of age only:I give permission for my child to participate in the Mission Trip.I affirm that my child is in good health, and that my child will follow instructions of Next Step Ministries staff.I certify that I am the parent/guardian of the minor mentioned herein, and I consent to the above statements on his/her behalf.I acknowledge that I have read this Release of Liability and have been given reasonable opportunity to discuss this with Next Step Ministries and, if I so choose, my lawyer. I acknowledge that I fully understand the terms of this Release of Liability, and that I have signed it freely and voluntarily.Participant Release of Liability Signature(Required)By typing in your name, you agree to this Release of Liability.Parent Signature(Required)By typing in your name, you agree to this Release of Liability.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. 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 myor 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.Participant Publicity Release Signature(Required)By typing in your name, you agree to this Publicity Release.Parent Signature(Required)By typing in your name, you agree to this Publicity Release.Email(Required) Enter your email address to be sent a copy of this completed form.This field is hidden when viewing the formSignaturesBy typing in your name and submitting this form, you agree to all its terms and conditions. Submitting, as used above, is defined as clicking submit at the bottom of this page. Participants under 18 requires parent/custodial signatures.This field is hidden when viewing the formParticipant Signature(Required)Participant Date of Signing(Required)This field is hidden when viewing the formParent Signature(Required)Parent Date of Signing(Required)
