Emergency Authorization: I hereby give permission to medical personnel selected by my trip leader or his/her designee (hereafter the Authorized Agent) to order X-rays, routine tests, and treatment for me. In the event of an emergency and neither my primary nor secondary contact can be reached, I hereby give permission to the physician selected by the Authorized Agent to secure proper treatment, hospitalize, order injections and/or anesthesia, and/or authorize surgery for me. I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. In addition, I have, and do hereby, release One 17 International, its employees or agents, and in country contacts from liability associated with participation in a mission trip. I understand that if I do not have medical insurance or workers compensation insurance, I will be responsible for any expenses in the event of a sickness, injury, or loss of wages. I understand that there are risks involved in participating in a mission trip. *
Thank you for filling at the trip agreement form. Your trip's coordinator will contact you with more next steps.