Participant Release Form

Complete one form for each individual attending CityConnexx (students and adults). Forms must be completed 4 weeks before your departure date.

Participant Release Form

Medical Release Form
  • Permission for: Photograph/Video/Testimony, and Release and Indemnity

    I understand that as a participant, my child or self may be photographed or videotaped during CityConnexx activities and these photos/videos/tesimonies may be used in promotional materials. I, the undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge CityConnexx and affiliates, the ministry site, event sponsors, and their employees and volunteers from any and all claims, demands, actions or causes of actions, past, present, or future arising out of any damage or injury while participating in the CityConnexx program or other activities while attending CityConnexx. I agree to indemnify CityConnexx and affiliates for any and all claims, demands, damages, injuries, costs, suits or causes of action, past, present or future, arising out of or caused by my child or self while participating in the CityConnexx program or while on property leased or owned by CityConnexx or the ministry sites.

  • Please sign this form by entering your first and last name
With a grant and on-going support from Compassion International, CityConnexx is dedicated to help people experience custom designed mission trips to ignite their passion for serving others as a life long vision.
Contact
PO Box 11909 Denver, CO 80211-0909 817-914-2671
©2016 CITYCONNEXX | SITE BY PARADIGM NEW MEDIA