2019 Fr. Thomas Gafney, S.J. Summer Mission Trip Registration and Deposit

You have been selected to participate in the Fr. Thomas Gafney, S.J. '50 Summer Mission Trip Program! Please use this form to complete your registration.

At the end of the form, you will be asked to submit your deposit. If you would like to pay for your trip, in full, at this time, that option will be provided as well. For families on a payment plan, you will use a separate form for the various installments of your trip payment.
If you would like to apply for financial aid, please contact Tony Krzmarzick at (216) 651-0222, ext. 552 or tkrzmarzick@ignatius.edu.

International Trips ONLY

Flight Information
The Saint Ignatius Mission Trip staff will make the plane reservations. The airfare is included in the total cost of your trip. Be assured every attempt will be made to secure the lowest possible airfare on a major carrier that can accommodate our group. Once tickets have been issued, they are non-refundable as specified in the ticketing agreement with the carrier.

If you consent to have the Saint Ignatius Mission Trip staff make your airfare reservations and travel with the group from Cleveland, please indicate so below.

ALL Trips
Assumption of Risk/Release
In consideration of the acceptance and participation of the student on such this Summer Mission Trip, the undersigned student and his parents or guardians, to the fullest extent permitted by the law, hereby release and agree so save, hold harmless and indemnify all adult directors, all host parents and members of their families, and all coordinators of Saint Ignatius High School, of and from all liability for any loss, property damage, personal injury or death, including any such liability which may arise out of the negligence of any such persons or entities, which may be suffered or claimed by such student, parent or guardian during, or as a result of the participation by such student in the Summer Mission Trip including travel to and from the trip location.

We give permission for any operation, administration of anesthetic, medication or blood transfusion which a medical practitioner may deem necessary or advisable for the treatment of any illness or injury suffered by the student.

We agree that the adults designated by Saint Ignatius High School may sign on behalf of the student and his or her parents or guardians any and all medical emergency release documents for any treatment that may be necessary during this trip and in the event that reasonable attempts to contact the parents/guardians are unsuccessful. We understand that we will be liable for any expense so incurred.

Publicity Release
Upon your son's acceptance in the Student Mission Program you agree to give permission to reproduce images of your son photographed or filmed throughout his travels abroad for use in print or online. His image may be used in the Saint Ignatius Magazine, marketing materials, advertising, the Saint Ignatius website, social media sites, newspaper/broadcast coverage, or other public forum. This permission is granted by you by virtue of your son's agreement to participate in the Mission Trip Program. If you do not agree to permit the use of your son's image as described you must inform us, in writing, prior to the first day of travel. For more information please contact Tony Krzmarzick at tkrzmarzick@ignatius.edu or (216) 651-0222 ext. 552.
Medical Information
Please answer the prompts below regarding student medical information and dietary needs.

Special Needs
Although we cannot assume responsibility for special needs, we try to accommodate everyone regardless of medical conditions, and we want to be prepared for any possible arrangements which must be made. If you will require a wheelchair during the trip (other than just at the airport) you need to bring one with you.

Emergency Contact Information

Waiver of Liability
In granting permission for attendance and participation in this activity, I hereby expressly waive any claim for liability for illness or injury against Saint Ignatius High School including its employees and representatives and release them from all liability for illness or injury in connection with this Mission Trip Program. My child is physically able to participate. We/I have medical insurance for my child. I hereby authorize Saint Ignatius High School and the adult chaperones of the trip to send my child to a hospital for diagnosis or treatment if necessary. Furthermore, I understand that the student may be out of the Cleveland area for most of this trip, and I grant consent for transfer of the child to the nearest hospital.

Participant Statement
All of the information that I/we have supplied on this registration form is a true and complete statement of the facts. I/we have read the terms and understand the conditions. To avoid any chance of confusion, any changes or additions to this reservation form must be made in writing. Upon receipt of your request we will send a written confirmation of the change you have requested.

Financial Aid

Financial Aid Request
Saint Ignatius High School is committed to doing all we can to make the mission trips financially affordable for students and their families. Financial aid is available, and we encourage those in need to apply for it. Are there special circumstances that will make it difficult to pay for the trip? Is there a dollar amount that you must have in order to make this trip? Please share with us the information that will help us determine what financial aid is appropriate to meet your family's needs.


Payment Information


Billing Address