Belmont Missions Trip - University Ministries - Plunge

In addition to this form, please fill out the following Risk & Release form and the Health Disclosure form.  Once completed, print them out, sign, and turn them into the Office of University Ministries. 

Risk & Release Form

Health Disclosure Form

*Forms will open in a new TAB
*Forms are due by Wednesday, October 7th, 2015.

Personal Information

* Enter your full legal name as it would appear on a passport.



















Emergency Contact Information






Payment Information














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“I understand that in submitting this registration, I am entering into a contractual agreement with University Ministries, that I am responsible for paying the project fees or any expenses incurred on my behalf, should I decide to withdraw from the project. I understand that University Ministries has the right to remove me from the project should I fail to meet the expectations stated in all materials/correspondence I receive in hardcopy and/or email.”