2024 Nicaragua Mission Trip

Participant Name: As It Appears on Passport*

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Participant Email*

please do not use a school email address as these often get rejected

Participant Cell Phone*

Participant Date of Birth*

Participant Gender*

Male
Female

Marital Status*

Single
Married

Passport Country Issued

Passport Number

Passport Expiration date

Please describe any medical conditions, allergies, or physical handicaps for which you will need special provisions or accomodations:

Please list any medications and dosages you are currently taking

Health Insurance Company

Primary Insured

Health Insurance Policy Number

Health Insurance Phone Number

T-Shirt Size*

Shirts are available in adult sizes only

Primary Physician Name

Primary Physician Phone

I anticipate I may have a need for additional financial assistance.*

Yes
No

Emergency Contact 1 Name*

First Last

Emergency Contact 1 Email*

Emergency Contact 1 Phone*

Emergency Contact 1 Relationship to Participant*

Parent/Legal Guardian
Spouse/Partner/Significant Other
Other

Emergency Contact 2 Name

First Last

Emergency Contact 2 Email

Emergency Contact 2 Phone

Emergency Contact 2 Relationship to Participant

Parent/Legal Guardian
Spouse/Partner/Significant Other
Other

Agreement*

I understand and agree to the below terms & conditions of my registration

By registering for the a Mission Trip through The Water's Edge and/or it's mission partners, I agree to the following conditions: 1. I am committed to going on this trip. My registration is a promise to the mission organization, my fellow mission trip participants, and to The Water's Edge that I will show up and serve. 2. My participation is contingent upon my ability to abide by the codes of conduct for The Water’s Edge and it's Mission Partners. 3. I am willing to develop and maintain a servant's attitude. 4. I will be a team member. We will be a team and not a group of individuals. 5. I will be flexible, patient, and cooperative. Schedules and plans may change during the trip. 6. I will respect the team leaders and their decisions. I will refrain from complaining and choose to be a problem solver, creative, and supportive. 7. I will be a learner of the methods and practices of those whom we serve alongside. 8. I will attend all pre-trip planning and learning meetings. I will do my best to attend any post-trip functions to celebrate our time together. 9. I alone am financially responsible for the full cost of attending the mission trip with WE and will work to meet the payment amounts and due dates. 10. I understand that failure to make a payment due date may result in the loss of my spot if a waitlist exists. 11. I understand, if accepted, my $200 deposit is non-refundable. 12. I agree to pay the remaining balance of the trip cost, as defined at the first team meeting, no later than two weeks prior to our team's departure for the trip. 13. I understand the published price of the trip does not include: the cost of my passport, meals while traveling, any necessary shots or medical exams associated with the trip, or spending money. 14. If I am under the age of 21, I agree that I will not drink alcoholic beverages during the mission trip, regardless of the local drinking age in the country I am visiting. I will also abide by any curfew restrictions set by the leaders of the trip. I accept the fact I will have an adult supervisor during the trip who is at least 21 years of age.

Adult Participant or Parent Legal Name Typed*

*Typing your name is your digital signature and agreement for this form.

Today's Date*

Deposit Payment Options*

*For online payment, click the link on the confirmation screen to go to our online payment portal. Online payments are subject to approximately 3.75% transaction fees. To ensure your full deposit is credited, please make sure to click the box indicating your desire to pay the fees in addition to the deposit amount. **For In Person Payment, please submit a check for $100.00 to "The Water's Edge."

Total

$0.00

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