Partnership Visit Application

Partnership Visit Application

As it appears on passport

Marital Status*

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( )   -

Emergency Contact Address*

,  

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If yes, please explain

How do you plan to finance this trip?*

I authorize Providence Church to conduct a criminal background check (if needed) with the information I have provided*

Failure to check “Yes” will result in your application being denied for acceptance

If under 18

Address

,  

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Have you shared your faith with someone else?*

Have you shared your personal testimony?*

Have you ever been on a short term mission trip?*

Cannot be a relative

( )   -

( )   -

In consideration of the benefits derived from my participation in this missions trip with Providence Church, I do hereby voluntarily release, acquit, and forever discharge the church and its directors, officers, employees, and agents from all manner of suits, actions, claims, demands, and liabilities which may arise from my participation in the trip. 

I recognize that the conditions in some of the places to which I travel are not the same standards as the conditions to which I am accustomed (I.e., political environments and judicial systems). I realize further that there are certain health and detainment risks as well as other risks to my property and me, and I enter into participation in this trip with knowledge of those risks.

I understand that this document constitutes a full and complete waiver of all possible claims, including claims for negligence in personal injury or property damage, arising out of my participation on this trip.

No provision of this document shall, in any way, limit my right to make claims against persons other than the church, its director, officers, employees, and agents.

I understand that by signing this release/disclaimer that I am bound to the contents therein.

*

Submit your deposit online via Pushpay. Please note applicant name in the comments field. 

 

You may also mail your deposit check to:


International Ministry Director: Melinda Snow
Providence Church
PO Box 663
West Chester, PA 19381

You can also mail copy of passport to International Ministry Director: Melinda Snow Providence Church PO Box 663 West Chester, PA 19381

Please check the steps you've completed:

 

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