Mission Builder Apply

Please answer all questions. Comment on all positive answers at the end of this form or on a separate sheet.

Have you ever had any of the following?

Release of Liability

I do hereby release Youth With A Mission INC, its agents, employees and volunteer assistants from any liability
whatsoever arising out of any injury, damage or loss which may be sustained by said person during the course of
involvement with Youth With A Mission.

Consent for Treatment

I hereby agree to the performance of such treatment, anaesthetics and operations as in the opinion of the attending
physician if deemed necessary on.

Consent for Burial

I agree that, in the case of my death while with Youth With A Mission, Youth With A Mission may carry
out the burial in the place of the deceased. If my family desires to have my body shipped home, my
family will pay for it. I hereby absolve Youth With A Mission and all its staff and associates of any burial
costs.