LAC MK Retreat Registration

Personal Information
Child's First Name*
Child's Middle Name*
Child's Last Name*
Age*
Father's Name
Mother's Name
Email*
Area*
Country*
Is a parent traveling with the MK?*
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Mobile Phone
What are the COVID test requirements for your country as of now for your child's return trip? (Ex: antigen or PCR testing)

Consent and Release
Costa Rica requires people traveling from some countries to have proof of having a yellow fever shot or else they will not be allowed to get on the plane to Costa Rica. Please research to find out if the country you are traveling from is one of those countries. By signing below I understand that I am responsible to confirm if my child will need proof of having a yellow fever shot to enter into Costa Rica.
I (we), the undersigned, being the parent(s) or legal guardian(s) of the child named above, do hereby consent to the participation of my (our) child in the LAC MK trip during 2022, including swimming, boating, hiking, sporting events, and any other activities customarily associated with a LAC MK trip. Further, I (we) certify my (our) child is physically able to and adequately trained to participate in such events, including swimming.
The United States requires proof of negative COVID-19 test or recovery from COVID-19 for all air passengers arriving in the United States. (https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-international-air-travelers.html) If you are traveling from within the US for the LAC MK retreat, we will still require you to have a negative test (at-home tests are OK).
I (we) do not authorize our child to participate in any of the following activities:
By signing below I do hereby give the LAC region, International Society of Missionary Kids, Assemblies of God World Missions, the General Council of the Assemblies of God, and any/all of their licensees and legal representatives the irrevocable right to use my child’s name (or any fictional name), picture, portrait, or photograph in all forms and media and in all manners, including but not limited to, composite or distorted representations for advertising, trade, or any other lawful purposes, and I waive any right to inspect or approve the finished product, including written copy, that may be created in connection therewith. I verify that I am the parent/guardian of the minor named above and have the legal authority to execute the above release. I have read this release and fully understand its contents. I approve the foregoing and waive any rights in the premises.
Signature*

LAC MK Retreat Registration

Step 1 of 3

Personal Information

Medical Information

Consent and Release