First, Middle, and Last Name as issued on Passport *

First Name

Last Name

Date of Birth *

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DD

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Date of Passport Issue *

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DD

YYYY

Passport Expiration Date *

MM

DD

YYYY

Volunteer Enrollment *

I acknowledge that I have voluntarily applied for enrollment in the above listed short term mission trip and in consideration of being permitted to participate in such trip, do voluntarily execute this “Release and Assumption of Risk” on behalf of myself, my heirs and next of kin, my personal representative and my estate.

Agree

Disagree

Risks Invovled *

I am aware of the hazards and risks to my person and property associated with serving in a mission’s capacity, such hazards and risks including, but not being limited to, death or injury by accident, disease, war, terrorist acts, weather conditions, inadequate medical services and supplies, criminal activity, and random acts of violence. I accept my assignment with full awareness of these risks, and, subject to any insurance coverages that may be available to me from any source, and only with respect to Raise the Roof Academy and its agents, officers, directors, and employees, I voluntarily assume all risks of death, injury, and illness associated with such risks, and any damage to my personal property, and I release Raise the Roof Academy and its agents, officers, directors, and employees from any liability whatever arising as a result of death, injury, or illness that I may suffer as a result of participation in the missions trip.

Agree

Disagree

Due Care *

I understand that every care and attention will be given to the health and comfort of the members/volunteers, but Raise the Roof Academy or its staff cannot be held liable for any injuries sustained which were not directly caused by their failure to take due care.

Agree

Disagree

Medical Care *

I hereby authorize the leader of the trip to secure such medical advice and services as may be deemed necessary for the health and safety of myself (or my son/daughter/ward) and I agree to accept financial responsibility, including in excess of the benefits allowed by provincial health insurance plans: a. Where the health and well being of the applicant is involved. b. Where all attempts to contact the parent or guardian have failed or where due to the nature of the emergency there was insufficient time to contact such parent or guardian. It shall be at the discretion of the Raise the Roof Academy Team Leader as to what action must be taken for the welfare and safety of the member/volunteer.

Agree

Disagree

Vaccinations *

I agree that I am responsible for, and will get, all of the required vaccinations for traveling to Uganda before our departure.

Agree

Disagree

Rules & Regulations *

I agree to abide by the rules and regulations imposed on participants by Raise the Roof Academy and its staff.

Agree

Disagree

Cooperation *

I agree that I will be cooperative and helpful to, and with, all other participants in the trip and will not be disruptive of the objectives established for the trip or as may be designated by the staff or group consensus.

Agree

Disagree

Physical Health *

I declare that I am in good physical health and believe that I am able without reservation or limiting conditions to physically withstand and cope with the indicated activities of this trip.

Agree

Disagree

Flexibility *

I agree to be flexible and serve in whatever service area is allowed and open to me on the mission field. I agree to refrain from complaining. I acknowledge that travel can present numerous unexpected and undesired circumstances, but the rewards of conquering such circumstances are innumerable. I agree to be creative and supportive.

Agree

Disagree

Respect *

I will respect the work that is going on in the country with Raise the Roof Academy or person(s) with whom we are working. I realize that our team will be there for just a short while, but that the local team is there for the long term. I will respect their knowledge, insights, and instructions.

Agree

Disagree

Personal Information *

I agree that I will not give out my phone number, address, email, or any other personal information, to the locals in Uganda. I agree not to make any promises to the locals in Uganda, financial or otherwise. This is for your protection and the protection of RTRA as an organization. RTRA is not responsible if you fail to uphold this agreement. If you have any questions, please discuss with RTRA Team Leader.

Agree

Disagree

Deposit & Full Payment *

By signing this contract, I am indicating that I have decided to participate in the mission trip and I plan to obtain the funds necessary to do so. I realize that all money received will be submitted to RTRA and will be administered as a personal "support account" that goes toward the mission trip and all monies are non-refundable. I understand that this account will be established with the submission of my initial deposit, and submitted application. In the event that funds raised exceed project costs, I understand that such excess funds may be used to cover other project costs. In the event that I do not participate in the mission trip, any charges incurred for me or on my behalf (airline cancellation fees, deposits, etc) will be deducted from my account, and I will be responsible for any deficit. I will pay any deficit within (60) days following notice to me of the amount of such deficit. Gifts become the sole property of RTRA. A gift to RTRA is a charitable contribution for federal income tax purposes to the extent permitted by law. Tax deductible gifts cannot be refunded. In the event I do not participate in the mission trip, gifts to RTRA will go to support other project costs.

Agree

Disagree

Emergency Contact Phone *

(###)

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Emergency Contact Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Fully Informed *

I acknowledge that I have been fully informed of the nature, scope and demands of the trip, and that I have met all of the prerequisites required for participation in this trip.

Agree

Disagree

Today's Date *

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DD

YYYY