2023 Fr. Thomas Gafney, S.J. '50 Summer Mission Trip: Registration and Deposit

Registration

Congratulations on your acceptance to the Fr. Thomas Gafney, S.J. '50 Summer Mission Trip Program. Please use this form to complete your registration.

Note that we do offer financial assistance if needed, as we do not want participation in the trip to be cost prohibitive. If you would like to apply for financial assistance, please fill out the following link: https://www.tfaforms.com/4907722

If you do apply for financial assistance, you will be notified of any aid amount prior to the full payment due date.

For any questions, please contact Mr. Michael Tracy at (216) 651-0222, ext. 4258 or mtracy@ignatius.edu.

Trip Selection

Student Information

First Name

Middle Name

Last Name

Student email address

Date of Birth

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Do you have a driver's license and/or passport?

YesNo

Student name EXACTLY as it appears on Driver's License and/or Passport. Enter N/A if not applicable.

Flight Information

The Saint Ignatius Mission Trip staff will make the airline reservations for all trips with air travel. 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.

Parent/Guardian: I agree to allow Saint Ignatius Mission Trip staff to purchase airline tickets on behalf of my son, and I understand that once the tickets have been issued they are non-refundable. Checking this box is considered by you and the School to be equivalent to your actual signature and shall have the same legal, binding authority.

Yes

Medical and Permission Form

ALL Trips

Medical Information

Please log on to Final Forms to make sure your son's latest medical history, health insurance and emergency contact information are updated. Please contact Mr. Tracy directly with any significant health concerns or if your son takes any prescription medications.

Assumption of Risk/Release
In consideration of the acceptance and participation of the student on this Summer Mission Trip, the undersigned student and his parents or guardians, to the fullest extent permitted by the law, hereby release and agree to 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 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.

Typing your name is considered by you and the School to be equivalent to your actual signature and shall have the same legal, binding authority.

Parent Signature

Billing and Financial Aid

Payment Information

Please place a $50 downpayment by February 12, 2023 to guarantee admittance on your mission trip.

Name on Card

Card Number

MM

YY

Code

Billing Email

Billing Address