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BHBC InsideOUT Mission Project Participation Agreement

Participant Personal Information

US Citizen?*

(If you have applied for a passport, please write your name as it will appear on passport).

Participant Medical Information
Is Team Leader authorized to approve medical treatment?*

In case of emergency, is participant covered by personal/family medical insurance?*

Are you presently under the care of a physician?*

Involvement

Have you ever been on a short-term mission trip?*

Testimony

If you have been on a BHBC InsideOUT mission project within the last two years and your testimony has not changed, check the corresponding box and just write the location and dates of the project you participated in.

Past participant: