Global Worker Agreement/Waiver Form

* Indicates a required field.

International Location/Country:*

Personal Information

Name:*

Date of Birth:*

Place of Birth:*

Citizenship:*

Address:*

Phone:*

Email:*

Enter Email Confirm Email

Gender:*

Male
Female

Marital Status:*

Single
Married

Spouse & Family Information

Name of Spouse:

Date of Birth:

Please list the name(s) and birth date(s) of your child(ren) - If applicable

Select the plus (+) symbol to the right to ad another row.

Child's Name:	Date of Birth:

Emergency Information

Emergency Contact Name:*

Phone:*

Medical Information:

Do you (or your spouse and/or child(ren) if applicable) have any medical condition(s) that we should be aware of that affect your ability to go to or stay on your field of service? If so, please describe in detail:

Are you (or your spouse and/or child(ren) if applicable) taking any medication(s) that we should be aware of that affect your ability to go to or stay on your field of service? If so, please list:

Select the plus (+)symbol to the right to add another row.

Passport Information

Global Workers deployed outside of Canada. Please fill in the following information exactly as it appears on your passport.

Name:*

Passport Number:*

Country Issued:*

Expiration Date:*

Spouse & Family Passport Information

Global Workers deployed outside of Canada. Please fill in the following information exactly as it appears on the passport.

Name:

Passport Number:

Country Issued:

Expiration Date:

Please add your child(ren)'s passport information, if applicable.

Name:	Passport Number:	Country Issued:	Expiration Date:

Questions & Comments

Do you have any additional questions and/or comments?

Acknowledgement & Signature

Please read the following agreement and waiver carefully. It includes releases of liability, waiver of legal rights and deprives you or any others of the ability to sue certain parties. By agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the registration process.

Please Note: All of the following checkboxes and fields are required and therefore MUST be selected/filled in order for this form to be processed.

Resources: Travel Advisories, Beyond Security Protocols

I, the undersigned, wish to participate as a Global Worker in the country selected above, conducted under the auspices of Apostolic Church of Pentecost of Canada Incorporated (ACOP), Global Harvest and Beyond. By selecting the following checkboxes and signing this form, I (and my immediate family, if applicable) acknowledge:*

Date Signed:*

Signature:*

Email

This field is for validation purposes and should be left unchanged.