Trip Registration

Promise Home Honduras

Online Mission Trip Registration
Which trip are you registering for?
Personal Information
E-mail
Full Name

First NameMiddle NameLast Name
Passport Number
Passport Expiration Date (Note: Passport cannot expire for 6 months after departure date)

MonthDayYear
Country Issuing Passport
Upload a scan or photo of your passport

Upload a File

Cancelof
Birth Date

MonthDayYear
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Gender
Marital Status
Name of Spouse
Emergency Contact Name
Emergency Contact Email
Emergency Contact Phone

Area CodePhone Number
Emergency Contact Phone2

Area CodePhone Number
Home Church
Pastors Name
Have you had previous experience on the mission field or traveled to a foreign country
If yes, please explain
If you are under the age of 18 you must contact Promise Home to recieve additional requirements to participate on a mission trip. Contact us at info@promisehome.org
Medical Information
How would you rate your current health?
Are you presently taking any prescription medication?
If yes, please explain
Have you ever experienced any of the following medical conditions?
Please explain any medical restrictions or handicaps that will require any special accomodations while in Honduras
Blood Type
List any allergies
Insurance Provider
Insurance Group #
Physician Name
Physician Phone

Area CodePhone Number
I understand the information I have provided will be held in the strictest confidence and will be used only in the event of a medical emergency. The only persons who will have access to this information will be the mission team captain and the medical team leader. I give permission to the medical team leader to share my medical history only with the local medical professional only in the event of a medical emergency. I further give permission to contact my physician should a medical emergency arise.
Covenant & Liability Release
Covenant: I hereby agree to abide by all the rules, recognizing that my participation in this mission trip is my covenant with Hogar de la Promesa (Promise Home) to respect and abide by its policies at all times throughout the mission trip.
Liability Release: I, do hereby release Hogar de la Promesa (Promise Home), its officers, directors, administrators, members, employees, team captains or team coordinators and/or team members and all associated parties from any and all liability, claims, demands or action which may occur as a result of any injury, whether accidental or otherwise, illness or other loss which the undersigned may sustain as a result, directly or indirectly, while participating in any of said mission projects and/or activities, or while traveling to, from and during said mission project by any mode of transportation. The undersigned further acknowledges that he/she has been fully advised of the hazards, conditions and environment in said countries in which the mission projects will be conducted and of various health and safe hazards, which exist, and he/she fully understands and assumes all the risks involved in participation on said mission projects.
Type Name for Electronic Signature
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Promise Home Honduras

Personal Information

Medical Information

Covenant & Liability Release