Volunteer Short Form

Name as appears on passport:*
Email
Please tell us which trip(s) you are interested in
Please note any changes in regards to your personal information (e.g., passport #, phone #, address).*
If none, just put "no changes" in the box.
I have read HIMM’s Information and Guidelines for Mission Teams.*
- Yes
- No
General Release
In consideration of Heal International Medical Missions arranging a volunteer assignment for me, I hereby release and forever discharge Rio Life Church or any board members from any and all claims that I may have, of whatsoever nature, relating to my time as a volunteer with Heal International Medical Missions. This includes, but is expressly not limited to death, bodily injury, personal injury, property damage, theft of property, economic loss or any other damage.
I have read and agree with the above statement:
Signature*
This is your electronic signature. Please fill in your first and last name.
First Last
Date*
mm/dd/yyyy

General Release