2016-2017 Mission Trip Registration

* = Required Field

Citizen, Status & Name required for all trips; other fields required for international trips only, and can be submitted later using Passport Update form if necessary

Medical History

Please provide as much information as possible in this section. You will have an opportunity to update via a form in the Team Members section of the website. All fields are required; please enter 0 in fields which your answer is none.
Mental/physical health conditions you are currently or have been treated for in the past (select all that apply)

Participation Policy

By participating in a mission trip through Lipscomb University, you are awarded an amazing opportunity to serve alongside students, faculty, staff and alumni in various locations across the country and around the world. Please carefully review the statements below; by checking the boxes below, you understand and agree to the following:

Lipscomb University Waiver

Please read the full waiver of liability found HERE as well as the summary of points found below. By choosing to participate in this trip, you are agreeing to the following with Lipscomb University - which includes Lipscomb Missions, staff members, your team leaders, and mission team hosts:
Disclaimer of Responsibility
  • I understand there are certain dangers, hazards, and risks inherent in domestic & international travel. The parties listed above are not responsible for any personal injuries or property damage that may occur.
  • Lipscomb University is not responsible for injuries, losses, or expenses resulting from circumstances within a trip, including but not limited to the actions of service suppliers (transportation carriers, hotels, government officials, etc), disruption of travel arrangements, weather, and civil/political unrest.
  • Lipscomb University reserves the right to cancel, postpone or modify a trip as deemed necessary by the appropriate parties.
  • Medical
  • I have provided complete and accurate information regarding my medical history, both current and past, in the Medical History section of this form.
  • There are no health-related reasons (emotional, mental or physical) that prevent or affect my participation in this trip.
  • I understand that I am responsible for my personal medical needs including insurance, medication, immunizations, and costs associated with destination-specific preventative care, treatment, or hospitalization
  • I agree to grant my team leaders the power and permission to make any emergency healthcare decisions that may arise (medical power of attorney). I understand that no responsibility is assumed for any injury, damage or expense that may arise from such decisions.
  • Conduct
  • I agree to abide by the rules contained in the Lipscomb University Student Handbook, regardless of my classification.
  • Agreement