Home Registration Form

Registration Form

Fill out your information and include all the necessary details that can help us make your experience more pleasant!

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    *The undersigned does hereby consent to such participant taking part in noted activity, with full understanding that insofar as such activity will involve missions, sporting activity, mingling with other individuals and groups; that there is always the risk of injury, illness, loss and possible consequent expense for medical, diagnostic and curative treatments, and incidental loss and expense, and the undersigned does for him/herself and for and on behalf of such participant assume the risk of such an expense, and does HEREBY WHOLLY RELEASE MR. ROGGER VIZCARRA AND COLCA MISSION TRIPS FROM ANY RESPONSIBILITY OR LIABILITY; ANY WAIVES AND CLAIMS OR CAUSES OF ACTION AGAINST IT OR ITS AGENTS THAT MIGHT ARISE ON ACCOUNT OF LOSS, INJURY, OR EXPENSE OCCASIONED BY ANY SORT OF ACCIDENT OR ANY OTHER CIRCUMSTANCE INVOLVING SUCH PARTICIPANT, AND AGREES TO HOLD HARMLESS MR. ROGGER VIZCARRA AND COLCA MISSION TRIPS FROM ANY RESPONSIBILITY OF LIABILITY, AND WAIVES ANY CLAIMS OR CAUSES THAT MIGHT ARISE ON ACCOUNT OF LOSS, INJURY, OR EXPENSE OCCASIONED BY ANY SORT OF ACCIDENT OR OTHER CIRCUMSTANCE INVOLVING SUCH PARTICIPANT AND AGREES TO HOLD HARMLESS MR. ROGGER VIZCARRA AND COLCA MISSION TRIPS IN EVENT ANY SUCH CLAIM SHOULD ARISE; AND THE UNDERSIGNED AGREES TO ABIDE BY THE RULES AND REGULATIONS, SUPERVISION AND DISCIPLINE SET AND APPLIED BY MR. ROGGER VIZCARRA AND COLCA MISSION TRIPS AND ITS AGENTS.

    The undersigned will furnish payment or insurance for any such payment, at his or her own expense. Furthermore, the undersigned gives Mr. Rogger Vizcarra and Colca Mission Trips and its agents permission to take and use photos, videos, stories, or any other recording of such participant or such participant's likeness for promotional or other purposes. Furthermore, in the event that such participant needs to go home earlier or later than planned and/or by way of transportation other than that which was planned due to reasons including, but not limited to, illness, injury, or failure to comply with Colca Mission Trips rules and policies, the undersigned agrees to take responsibility for any and all additional expenses, arrangements, and inconveniences necessitated by such action, and the undersigned agrees to release Mr. Rogger Vizcarra and Colca Mission Trips and its agents from all expense and liability, whether financial or otherwise.

    Authorization: By signing below, I affirm that I am the above named participant and I am at least 18 years old, or that I am the natural parent or legal guardian of the above named participant and that I give permission for my son/daughter to attend and participate in Mr. Rogger Vizcarra and Colca Mission Trips function named above. I have read the above Waiver of Liability and agree to its provisions.


    I have read the Participant Agreement and Travel Guidelines, and I agree.

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