Ministry Trip Application – Part 3


In the case of an unforeseen emergency on this ministry trip, the health and safety of our guests is of utmost importance to us and we want to be able to respond appropriately to the best of our ability. Please provide the following information.

People you want us to contact in case of emergency overseas:

Shot/Immunization Record and Information:

Routine vaccines:

The Center for Disease Control ( suggests that before internationals trips, travelers are up to date on routine vaccines. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, (and a yearly flu shot if you choose to).

Note: The vaccines listed above may or may not encompass full preparedness for this trip. Therefore, we strongly urge guests to visit, look up the country Indigenous Ministries has invited them to, and follow the CDC’s advice on vaccinations and medical precautions to take before/during and after traveling to these areas. Additionally, we strongly suggest our guests consult with their physician and receive instruction and assistance with preparation medically for this trip.

List any other vaccines you have received:

MEDICAL PERMISSION: I authorize Indigenous Ministries International staff members, US or Indigenous (overseas), to obtain medical treatment for me in the event of injury or illness and agree to pay any expenses incurred for treatment. I give permission for the medical information above to be used in my medical care overseas. I understand that in an emergency, US Indigenous Ministries an national team leaders will do everything to get me the care I need, but may not be able to access the medical care I need if it is not available in that country or area.

By writing your name here, you agree this is your signature and you have filled out the Emergency Contacts, Information & Release form and filled it out accurately.

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