MEDICAL RELEASE 

THIS FORM SERVES AS A MEDICAL RELEASE FOR GRACE POINTE  

BOGOTA, COLOMBIA MISSION TRIP 2020 

Name *
Name
Address *
Address
Phone *
Phone
Insurance Coverage
It is expected that you have medical insurance. Your carrier will be billed for medical charges in case of illness or injury related to the activity.
Phone
Phone
In case of emergency notify:
Name 1 *
Name 1
Phone 2 *
Phone 2
Address 1 *
Address 1
Rules of Behavior Expected of Each Participant:
No alcohol or drugs permitted. Attendance at meetings mandatory. No tobacco. No profanity.