Mission Trip Registration – Evangelist Ethan LeCroy

Evangelist Ethan LeCroy

Mission Trip Registration Form

Please use the form below to register.

Please note that there are five pages that you have to go through (you have to enter information on each page and click “Next” four times and then press the “Submit” button on the last page). There is a required digital signature on the last page. If you do not complete the required information on all five pages and digitally sign it, the registration will not be made. You will get a confirmation message (and be redirected to the payments page) as well as receive a confirmation email when the registration is completed. If you are not redirected to the payments page, the registration is not completed.

Covid Requirements:
Panama – Panama has dropped the vaccine requirement to get into the country. Those who are unvaccinated can get into the country with a negative COVID test and back out with a negative test.

You will need a passport to go on the trip as well. If you don’t have a passport, you can find information on getting a passport here (note that it takes 8-11 weeks to get a passport (5-6 weeks if expedited) so please plan accordingly).

If you have any questions or experience any issues, or if you are unsure if the registration was successful, please contact us at registration@evangelistethanlecroy.com and we will be happy to help.

---------- PERSONAL INFORMATION ----------

Trip Identifier * Name (as it appears on your passport) *

Contact Information * Birthdate * Age Range on Date of Trip * Gender * MaleFemale

---------- EMERGENCY INFORMATION ----------

In Case of Emergency Notify: *

Relationship to Traveler * Phone Number(s) *

Are there any medical restrictions or disabilities that we should know about? * Yes_Restrictions_or_DisabilitiesNo_Restrictions_or_Disabilities

Please provide a description of your restrictions or disabilities

Are there any known allergies to Medications, foods, insect bites, etc.? Yes_AllergiesNo_Allergies

Have you ever experienced an allergic reaction which required emergency medical care? Yes_Allergic_ReactionNo_Allergic_Reaction If so please list the items you are allergic to and the severity of your reaction

Please list any current medications you are taking.

---------- REFERENCES ----------

Are you a member of a local church? * YesNo How did you hear about this trip? * At my churchFrom a friendevangelistethanlecroy.com website

---------- PASSPORT ----------

Do you have a valid passport? * YesNo How I will provide my passport * UploadMail

Upload a copy of the passport declaration page (the page with your picture).

Please make a copy of your passport declaration page (the one with your picture), and mail it to the following address. Please note your trip number and travel dates on the back of the copy. Missions Initiative Trips (MIT) New Life Baptist Church 1405 Simpson Road Odenville, AL 35120

---------- LIABILITY WAIVER ----------

Are you under 18 years of age? *

Yes_Under_18No_Not_Under_18 Liability Waiver

I desire to participate on the above listed mission trip (the “Trip”) hosted by Evangelist Ethan LeCroy. I understand that Evangelist Ethan LeCroy will not allow me to participate in the Trip unless I enter into this Assumption of Risk and Release of Liability (the “Agreement”). Therefore, in exchange for permission to participate, I make the following representations and agreements, which I understand Evangelist Ethan LeCroy is relying on:  1. I am of sound mind, in good health, and no physical or mental conditions will hinder me participating in the Trip.  2. I am a volunteer embarking on a missionary venture with other volunteers. I understand that any representations made regarding the Trip, via any medium, are speculative in nature. I understand the risks and acknowledge the potentially volatile nature of a trip of this nature, any speculations by any agent of Evangelist Ethan LeCroy about the safety of a trip to this area are not substantive, nor are they to be relied on by any party, as circumstances are subject to change at any time.  3. I understand that the terms of this Agreement are contractual and legally binding on me, and on my representative heirs, estates, beneficiaries, successors, and assigns.  4. I am aware of the hazards and risks to my person and property associated with serving in a mission capacity, including, but not limited to, injury or death by accident, disease, war, terrorist acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence, and that such risks have always been associated with missionary service. I embark upon the Trip with full awareness of these risks, and, subject to any insurance coverage that may be available to me from any source, and only with respect to Evangelist Ethan LeCroy and its agents, officers, directors, and employees, I voluntarily assume all risks of illness, injury or death associated with such risks, as well as any damage to my personal property.  5. I understand that domestic travel, foreign travel, and/or staying in a foreign country involve risks and can be dangerous. By my participation in the Trip, I voluntarily expose myself to these risks and dangers, whether expected or unexpected. I am aware that I may obtain additional insurance coverage at my own expense. I further understand that Evangelist Ethan LeCroy is providing basic insurance coverage that would apply in the event of my illness, injury, or death, or damage to my property that may occur during the Trip. 6. I release and discharge Evangelist Ethan LeCroy from any and all liability and responsibility for any loss, damage, or injury of any kind that I may suffer as a result of or in connection with my participation in the Trip. This release covers any loss, damage, or injury caused by:  a. criminal, illegal or unauthorized acts of third parties, including but not limited to any terrorist act, hijacking or sabotage;  b. social or labor unrest;  c. political conditions;  d. mechanical or constructional difficulties or condition;  e. diseases, local laws or climatic conditions,  f. conditions, developments, actions or omissions outside of the control of Evangelist Ethan LeCroy and,  g. any other expected or unexpected conditions, developments or risks connected with domestic travel, foreign travel, or staying in a foreign country, even if I suffer the loss of money, property, health, or life, and irrespective of who is or may be at fault, or whose negligence, including the negligence of Evangelist Ethan LeCroy may have caused my loss, injury or death.  7. I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms.  8. I expressly agree that this Assumption of Risk and Release of Liability agreement is intended to be as broad and inclusive as permitted by law. I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND RELEASE OF LIABILITY AND UNDERSTAND ITS CONTENTS, AND I VOLUNTARILY SIGN THIS RELEASE AS MY OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I HAVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING IT.  9. I recognize that Christians are called by scripture to a different standard of resolving their differences, (Matthew 18; 1 Corinthians 6). In the event a dispute arises out of, or relates to this Event, I shall first make a good faith attempt to settle the dispute by mediation administered by the religious dispute division of Mediation Law GroupTM (MLG) or another Christian dispute resolution service, before commencing arbitration, litigation, or other dispute resolution procedure. In the event I am unable to resolve the dispute by mediation, I shall submit the claim(s) to binding arbitration administered by the religious dispute division of MLG, or another Christian dispute resolution service, under its arbitration rules, and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. I further acknowledge that where emergency interim relief is required by a party to this agreement, including but not limited to injunctive relief and orders for the protection or conservation of property and/or disposition of disposable goods, such relief may be granted by an arbitrator upon application under applicable arbitration rules, even when the dispute is still in the mediation phase of resolution. I acknowledge and agree that an application for such emergency interim relief shall not constitute a waiver or breach of mediation requirements under this provision. IF ANY PARTY HERETO INITIATES COURT PROCEEDINGS BASED UPON A DISPUTE TO WHICH THESE PARAGRAPHS (SECTION 9) APPLY, WITHOUT FIRST ATTEMPTING TO RESOLVE THE MATTER THROUGH MEDIATION AND ARBITRATION, THEN IN THE DISCRETION OF THE JUDGE, SUCH PARTY SHALL NOT BE ENTITLED TO RECOVER ATTORNEYS’ FEES, EVEN IF FEES WOULD OTHERWISE BE RECOVERABLE BY THAT PARTY IN ANY SUCH COURT PROCEEDING.

By clicking, I acknowledge that I have read and understand the terms included in the Liability Waiver. *

Signature of traveler *

(If under 18 years of age) Parent or guardian's signature *

(use mouse or finger to sign)

Type Your Name and Enter the Current Date *

Evangelist Ethan LeCroy

Mission Trip Registration Form

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