"*" indicates required fields

Global Worker Agreement/Waiver Form

* Indicates a required field.

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.

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
Please indicate above the country you are deploying to. Note that, before departing for any country outside of your original country of deployment/posting, you are required to notify the ACOP Global Harvest office (staff member in charge of the ACOP medical insurance program) and Missions Directors, even if you may not be covered by medical or liability insurance in any country you are travelling to. Note that you are personally taking all responsibility for potential risks. Please indicate to ACOP Global Harvest staff any alternative country you are travelling to and the dates you will be travelling.

Personal Information

Name:*
MM slash DD slash YYYY
Address:*
Email:*
Gender:*
Marital Status:*

Spouse & Family Information

Name of Spouse:
MM slash DD slash YYYY
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:*

Medical Information:

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(s).
Name:*

Spouse & Family Passport Information

Global Workers deployed outside of Canada. Please fill in the following information exactly as it appears on the passport(s).
Please add your spouse/family member passport information, if applicable.
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

I, the undersigned, wish to participate as a Global Worker in the country selected above, or other countries I may choose to travel to, 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:

I am fully aware of and accept the potential risks and hazards connected with travel to and within this country, or other countries I may choose to travel to, and I voluntarily assume full responsibility for any risks of loss, property damage or personal injury that I may sustain as a result of participating in this project. I release ACOP / Global Harvest and their employees, agents, trustees, directors, and other officers from any liability for injury, damage, or harm which may occur to my person or property in connection with my participation in this mission project, whether upon the premises where the project is being conducted, while in transit to or from the premises, or in any place or places connected with this project.
I am covered for medical emergencies. If I am not covered for medical emergencies in any country I travel to, I will make alternative arrangements in the event of a medical emergency.
I have reviewed and accept the security situation and travel advisories for any country or area I am travelling or deploying to.
I have discussed with my immediate and extended family members in Canada the security situation of any area to which I am travelling or may be travelling to and have advised them that I accept full responsibility for travelling to any country or area that is listed as “Avoid all Travel”.
That I am ready to endure the challenges I may face, and to engage in loving service for the Lord and a lost world.
That my expectation is to complete the ministry agreed upon unless matters beyond my control are permitted by the Lord to close a door for me. If there is a ministry change, I agree to consult with and seek direction from ACOP/Global Harvest/Beyond before making the change.
That my supreme purpose in serving as a Global Worker is to glorify Christ through widespread witness, through winning souls, through discipling, all for the building of the Church of Jesus Christ.
That I have consulted with my family physician and have received the recommended inoculations and/or medications required for any destination I travel or am deployed to. I am aware and accept any potential risks involved in not following my physician’s direction or orders. I affirm that any medical history and/or pre-existing medical conditions will not prevent me from safely travelling to or from any destination or will affect me while participating in proposed travel activities.
I give ACOP, Global Harvest, and Beyond and their representatives in my country of posting authority to request and authorize medical and/or hospital treatment for my benefit in the event of any injury or sickness sustained by me while on the field, including, without limitation, while travelling to and from any foreign country. I agree to pay the cost of any such treatment not covered under my insurance policy and to reimburse ACOP, Global Harvest, and/or Beyond and their representatives for any and all costs and expenses incurred with respect to such treatment.
It is my express intent that this release shall bind me, my spouse, and family members (if applicable), my executor, administrators, and heirs, and shall be deemed as a release, waiver, discharge, and covenant not to sue ACOP, Global Harvest, Beyond or their employees, agents, trustees, directors or other officers.
I have read, understood, and will follow applicable Security Protocols (for Beyond Global Workers).
I have read the foregoing release, understand it, and sign it voluntarily and without duress.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.