CLM Missions Trip
The CLM Mission trip will serve as a unique opportunity for participants to celebrate and deepen their faith in community while serving in the mission of the Church. They will delve deeply into the topics of global solidarity and the evangelization of the world.
Costa Rica & El Salvador
July 6 – 19, 2015
Registration Form
I,______, Student or ID # ______, Email ______would like to participate as a volunteer in the CLMMission Trip.
I know that the goals of this CLM Trip are:
-To develop and share our Catholic faith.
-To interact with locals on a voluntary basis, working in community development projects on site.
-To have a cultural immersion experience.
-To have a community experience with other students by working with local people in a spirit of solidarity.
Please include a copy of your passport when submitting your registration form and deposit of $500.
I agree with and have signed the Assumption of Risks, Responsibility and Liability Waiver.
To be considered part of a group going on these CLM 2014 Trip, I acknowledge that I should pay the deposit of Cn$500. It will be the first installment, used to reserve my spot on the CLMTrip. Cheques are to be issued to the order of Christian Life Movement. This registration deposit is part of the CND $2200 (subject to changes) cost of the CLMTrip. I’m aware that this deposit is non-refundable if I withdraw my participation.
______Signature Date E-mail
CLM Missions Trip Important Information
Full Name (as it appears on your passport): ______Passport Number: ______Date of Birth: ______E-mail address: ______Alternative E-mail address: ______University and student number: ______(If applicable) Land line contact Phone Number: ______Cell Phone Number(s) (optional): ______University Major(s): ______Minor(s) ______(If applicable) Postal Address: ______
In-case-of-emergency name(s) and phone number(s) of contact(s) and their relation to you:
1) ______
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2) ______
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Medical comments (optional): (ie. Allergies, special food considerations, blood type, mental health challenges, medication) ______
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Please state any comments or concerns you may have:
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CLM Missions
Assumption of Risks, Responsibility and Liability Waiver
I,______, Student or ID # ______, Email ______hereby declare my intention to participate in the CLM Missions trip.
I understand that my participation in the CLM Mission Trip Program will take me away from campus for an extended period of time. During this period, I understand that I will be in unfamiliar surroundings and will be exposed to risks to my person and possessions. I understand that I may suffer personal injury, sickness, death, or damage to my belongings as a result of my participation in this program. I, freely and of my own volition, accept and assume responsibility for all such risks, dangers and hazards.
Accordingly, I understand that despite its best efforts, (the Christian Life Movement –may not be able to ensure my complete safety at all times from such risks and dangers.
Assumption of Responsibility: I understand that it is my responsibility to abide by all applicable CLM, and host institutions’ policies and regulations, and to ensure that I have adequate medical, dental, travel and accident insurance or health card coverage, as well as protection of my personal possessions. More particularly, I understand that the CLM does not have to carry accident or injury insurance for my benefit, besides the travel and medical insurance bought for this CLMTrip, and that there may be certain circumstances for which I may personally be held at fault if the accompanying conditions do not relate or arise from my education or if my activities or conduct fall short of what would be considered a reasonable expectation for an individual in my position.
I further acknowledge that I must be aware of and abide by the acceptable cultural norms and standards for appropriate behavior in the locations where I will be staying, and I recognize that inappropriate conduct may result in disciplinary action or termination of my involvement in the above mentioned CLMTrip, at the discretion of the CLM leaders or the host institutions/organizers or employer (as described in their own rules and procedures for conduct), with no financial recourse. I agree to be accountable in all respects for my own actions and not to expect the CLM or its employees to accept the consequences thereof. Furthermore, I agree to be responsible for any claims made in relation to any such actions.
I acknowledge that I have been advised by the CLM of such risks and dangers as well as the need to act in a responsible manner at all times. My signature below is given freely in order to indicate my understanding of the acceptance of these terms and in consideration for being permitted by the CLM to participate in the above-mentioned CLMTrip. I recognize that theCLM will not supervise any academic programs; also no living arrangements different than the specific CLMTrip. I further acknowledge that I am of legal age in the Province of Ontario, and will inform myself of and abide by the legal age limits, laws and regulations for all other jurisdictions where the activity or program occurs.
Liability Waiver: I release and hold harmless CLM, its employees, students and agents from any and all liability for any loss, damage, injury or expense that I or my next of kin may suffer as a result of my participation in this program, including, but not limited to, accidents, acts of God, civil war unrest, sickness, transportation, scheduling, government restrictions or regulations, and any and all expenses which may incur while participating in the CLMTrip.
This waiver is effective for the period of time that I will be participating in the above-mentioned program and associated activities. I understand that this agreement cannot be modified or interpreted except in writing by the CLM and that no oral modification or interpretation shall be valid. This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns, in the event of death.
I certify that I have read and understood this waiver form:
______Signature of Student Signature of Witness Date
______University ID Number(if applicable) E-mail Contact Phone Contact
CLM Missions Trip Statement of Interest Form
In order to ensure that all students have an opportunity to participate in this program, a method of selection has been instated. We are asking each applicant, in 250-500 typed words, to answer the following questions or to discuss other social justice related issues: Why you would like to participate in the Christian Life Movement MissionTrip? What does social justice mean to you? What expectations do you have of Christian Life Movement Mission Trip? What reasons drew you to choose the country that you did?
Once we have received all applications, we will contact selected applicants to arrange a short interview to discuss involvement in the program in greater detail.
I understand that if Iam NOT selected to participate in the CLMTrip my Cn$500m deposit will be returned to me.
I, ______, University or ID # ______, Email ______hereby declare my intention to participate in the Christian Life Movement Mission Tripfor the following reasons: ______(use another sheet of paper if needed or the back of this sheet)______
Student Signature: ______Date ______
PHOTO PERMISSION
I, ______hereby give permission to freely use pictures from the CLMMission Trip taken by myself or in which I appear for use in promotion and posting on their webpage to the CLM, and local partners, etc.). I understand that my photographs may be open to public view and will be used with due discretion. If at any time I change my mind, I will contact the CLM Trip Leaders, to inform them of my decision and will allow one week for any changes to their website.
______Signature Date