VII Misión Médica Internacional Amazonas 2019 · VII Misión Médica Internacional – Amazonas 2019 “UNIDOS POR UNA MISMA CAUSA” Sponsored by Christian Life Movement (CLM)

VII Misión Médica Internacional – Amazonas 2019 “UNIDOS POR UNA MISMA CAUSA”

Sponsored by Christian Life Movement (CLM) , Solidaridad en Marcha, & Club Amazonas-USA. Introduction: We are an organization that recruits groups of doctors, nurses, and volunteers to plan medical mission trips to Peru three times a year. We gather volunteers from the United States with centers in Miami and Denver, Peru with a center in Lima, and Canada with a center in Toronto. We welcome people from all walks of life who are able and willing to help those in need. Next Trip: From August 9th to August 16th, 2019, we will be doing our VII mission to the Amazonas region in Peru to provide basic medical care to the less fortunate people living in several towns throughout this part of the mountains far from the Peruvian coast. Last year, our missions to Peru helped thousands of people by providing medical care to several communities and their families. We are always in need of Doctors (Internal Medicine, Family Practice, OB/GYN, Rheumatology, Endocrinology, Neurology, Pediatrics, Dermatology, Cardiology, Ophthalmology, Podiatry, Surgery, Dental, etc.) ARNP’s, PA’s, Pharmacists, Paramedics, and Nurses. However, everyone is welcome, even if you do not have any medical background, there are many things that you can do to help us on our mission. Meetings: In an effort to ensure the smoothest possible execution of all the mission tasks, we will be holding a couple of meetings in Miami, Florida before August of 2019 and also in Lima, Peru before our departure. Air Travel: We will be flying with LATAM Airlines from Miami to Lima (Flight Number LA 2461) on the 8th of August and then flying from Lima to the city of Jaen (Flight Number LA 2300) the same day. Flights will be modified for those flying from other cities. Our goal is to have as many out-of-town (non-Miami residents) mission members as possible participate in the mission and fly out of Miami with us. The main group will be departing from Miami on August 8th at 01:55 AM and will be arriving to Lima, Peru at 6:43 AM, therefore we will meet at Miami International Airport (MIA) the night before at 11:30 PM; then at

http://clmusa.org/

http://www.solidaridadenmarcha.org/

VII Mision Medica Internacional – Amazonas 2019

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11:34 AM, we will be taking a flight to the city of Jaen (Flight Number LA 2326). From Jaen we will travel 3 hours by Bus to the City of Chachapoyas. Regarding our return, we will be departing from Chachapoyas and travelling to Jaen by Bus, on August 16th at 12:30 PM to then take a flight from Jaen to Lima (Flight Number LA 2301) at 05:15 PM, then from Lima to Miami (Flight Number LA 2466) on the following day (August 17th) at 12:15 AM, which will land in Miami the same day at 7:10 AM. For your travel arrangements, please contact Ketty Gilvey @ Atlantis Travel at 305-222- 8968. We are requiring that everyone participating in this mission must fly in and out of Miami on the same flights. We realize that some volunteers may want to use frequent flyer miles to pay for their tickets using other airlines or may have other travel plans pre or post the mission dates. In these cases, we will NOT be able to make any special arrangements for transportation, lodging, or luggage storage for anyone who travels outside the group itinerary. Therefore, you will be responsible for your own transportation and lodging for all dates and times that fall outside of the group’s itinerary.

Baggage Instructions: Please take all TSA regulations into consideration when packing your bags as there are no exceptions for those traveling on mission trips to Peru. Each person will check in 2 bags and one carry-on. Please be aware, there have been thefts of items placed in checked luggage. Therefore, keep anything valuable in your carry-on and be sure to place a TSA approved lock on your checked luggage. Please do not take expensive jewelry, cameras or other valuables on the trip. Make copies of your passport and/or credit card in case of an emergency. Please bring electrical converters to charge any electrical equipment. You may want to consult your cell phone carrier regarding international phone service if you so desire. We will later provide you with the addresses and phone numbers of the hotels where we will be staying as well as the name of local contact persons to leave behind for your families. Please check the latest airline policy regarding carry-ons and checked bags. For LATAM Airlines’ baggage information, please visit https://www.latam.com/en_us/travel-information/baggage/carry-on-baggage/ Note: Upon landing in Peru, go through immigration, pick up your own luggage, clear customs, and then exit the building. Thereafter, exit the building where a CAUSA staff member will be waiting for you with a sign. If the staff member is not present, just wait outside the building until the representative arrives.

What to bring with you: Priority Personal Items you “Must” bring: ✓ Basic Supplies to conduct Patient Exams

• Gloves (enough for one week)

• Stethoscope, medical flashlight, pocket otoscope/ophthalmoscope

• Lots of hand sanitizer ✓ Personal Hygiene/ Toiletries ✓ All Personal Medications

https://www.latam.com/en_us/travel-information/baggage/carry-on-baggage/


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✓ Enough clothing and scrubs to last your entire deployment. (There are few laundry facilities available) We also suggest bringing the following: ✓ Fanny pack to keep passport with you at ALL TIMES

✓ Sun block/ Hat ✓ Protective Footwear/ no clogs, open toes ✓ Flip flops for shower area

✓ Bathing suit (You may want to enjoy the refreshing waterfall of the Amazonas forest). ✓ Baby Wipes (An excellent way to freshen up) ✓ Toilet Paper ✓ Earplugs. Warning: It is unlawful to bring medications or medical supplies that will expire within 14 months. Any such medication will be confiscated by the authorities. Tourism: Peru is a fascinating destination and the Amazonas region is particularly an amazing place to

visit with several historical attractions like the forbidden fortress of Kuelap (Built by a Pre-Inca

civilization more than 800 years old) and the cataracts of Gocta (the third tallest in the world). Usually

after the medical missions are done, some of the volunteers decide to stay a few extra days in Peru in

order to sightsee and explore at their leisure. However, since the Amazonas region is so far from the

capital and for our own safety, our hosts, and local mission sponsors have arranged group tours to the

most important places in region during our last 3 days there. The cost of this 3-day escapade is already

included in the mission fees.

We will be visiting Kuelap on Monday August 12th, Gocta on Tuesday August 13th and will be feasting in

Chachapoyas our last day there Wednesday August 14th. For those participants who may have already

visited Kuelap and/or Gocta, we have a second option available which include visits to Rodrigues de

Mendoza and Leymebamba.

Rodriguez de Mendoza, is a charming district south-east of Chachapoyas famous for the quality of its

coffee and the friendliness of its people. Speleologists from all over the world gather here to explore the

hidden beauty of the famous local caves. The most popular two are named ‘Caverna de Leo’ and

‘Cavernas de Omia’. In Leymebamaba we will visit the Leymebamaba Museum, which was built to

provide a place for the preservation of the mummies and archaeological materials recovered from

Laguna de los Cóndores in 1997. This work was conducted by Centro Mallqui with contributions from

the international communities from Austria, Finland, Italy and the U.S., as well as significant

contributions from the Institute for Bioarcheology, the von Hagen family and the Discovery Channel.

About Peru: Please note that Peru is a relatively safe country; however, we are unable to completely guarantee your safety, especially if someone does things outside the itinerary or leaves the group. For these same reasons, we do not allow minors unless a parent or guardian accompanies them. We will provide security for the group at all times. However, you will be responsible for your own safety if you choose to arrive earlier or stay beyond the set mission dates.


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Housing & Meals: We will be staying at a hotel in the city of Chachapoyas. The total cost per person will be $675 for the 8 days of the mission, which equates to 84.37 per day and covers the costs of local transportation within the Amazonas region, lodging in Chachapoyas, three daily meals, a vest (required to identify you during the whole trip), and lastly the three-day tour mentioned in the Tourism paragraph on the previous page. Donations: All donations in the US are tax deductible (Club Amazonas USA is now a 501c3 tax-exempt corporation). The Medical Mission to Amazonas - Peru Team: For mission questions and registration, please contact: Silvina Gorbitz & Lourdes Chávez Zumaeta Mission Coordinators [email protected] Dr. Cesar Mendoza & Dr. Enrique Torres Quiroz Medical Coordinators [email protected]

mailto:[email protected]

mailto:[email protected]


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Application Process

1. Welcome Letter

2. Complete registration forms A & B

3. Complete the Assumption of Risks, Responsibility, and Liability Waiver.

4. Enclose a photocopy of your passport and Professional Licenses

(passport must be valid until 6 months after landing).

5. Please submit your application with a copy of your deposit ($ 675.00).

Checks should be issued to: Club Amazonas USA, please make a Direct

Deposit, to Club Amazonas USA, Chase Bank, account # 203571295


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Welcome Letter

Dear volunteer, Welcome!

The Club Amazonas USA (CAUSA) team is elated to have you on board. The Amazonas region is a

geographically and culturally rich region which harbors one of the most ancient American civilizations.

Even though it’s increasingly recognized for its history and legacy, the region is by far one of the poorest

regions of Peru with massive healthcare problems, illiteracy, and lack of education amongst the most

dangerous and common threats.

We aim to improve the healthcare of the under-served people of the Amazonas region in Peru by

providing them with direct basic medical, surgical, and dental care as well as providing training to local

providers. CAUSA works in close collaboration with partners including CLM, SEM, different Peruvian

institutions, and the Local & Regional Governments of the Amazonas region.

Due to the overwhelming interest in our upcoming mission, this year, we will trying things a little

differently by starting things off a little earlier than previous years and placing all “non-medical”

volunteers on a waiting list. All who have attended our Peru Medical Mission in the past will be given

priority as well as anyone that has specific technical and/or logistical skills helpful to the execution of

our mission. We are still in need of Doctors (IM, GP/FP, GYN, Pediatrics, Gastroenterologists,

Cardiologist, Dermatologists, Podiatrists, Surgeons, etc.) ARNP’s, PA’s, Medical Students, Paramedics,

Nurses and Pharmacists.

Those who are unable to attend the mission and are passionate about wanting to help, please know that

we will need your help with pre-mission preparations, gathering donations, making phone calls etc.

Within the next couple of weeks, we will forward a list of needed supplies as well as some letters that

you can use when asking your friends and family for donations. Please let at us know how you would

like to help.


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The purpose of these guidelines is to provide you with information that will make the coordination

process more efficient and your trip more effective.

Thank you for your participation.

YOUR CAUSA TEAM


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Registration Form A: Medical Mission to Amazonas - 2019

I, ____________________________________ (name as it appears on your passport), with

Passport# ____________________, Would like to participate as a volunteer on the VII

International Medical Mission – Amazonas 2019 Mission Trip. I know that the goal of the

Mission Trip is organized by Club Amazonas USA and Christian Life Movement to promote dignity

of every human person through:

a) Providing competent health care to the needy in Amazonas Peru.

b) Motivating, educating and supporting medical and non-medical volunteers in the generous

and fraternal giving of oneself in the service of others.

c) Creating an atmosphere of safety, compassion, respect, care and dialog for the mission’s participants

and the needy we serve. Volunteer members are prohibited from photographing or audio recording

patients or the patient’s visitors during the mission for personal use, including, but is not limit to: 1- Taking

pictures to share with friends and 2- Posting on the internet via social media.

I agree with and have signed the Assumption of Risks, Responsibility, and Liability Waiver. To be

considered part of the group going on this Mission Trip.

___________________________ ____________________________

Signature Date


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Personal Information B: Medical Mission to Amazonas – 2019

Full Name (as it appears on your passport): ______________________________________________

Passport Number: _______________ Passport Expiration Date: ______________

Please attached a copy of your Passport.

(For Passport information view the US Department of State Website for travelers to Peru at:

http://travel.state.gov/content/passports/english.html)

Date of Birth: _____________________________ Male/Female: _________________________

Occupation: _______________________________ Specialization: ________________________

* Health professionals, please attached a copy of your professional license.

Are you Peruvian? Por favor especifique su colegiatura o RNE______________________________

Postal Address: ________________________________________________________________

E-mail address: ________________________________________________________________

Cell Phone Number: ____________________ Land Phone Number(s): ___________________

Languages: Native _______________________ Second ______________________________


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Remember that your personal information on your travel documents must perfectly match the

information on your ticket. If you are deemed to be improperly documented, the airline has the

right to refuse to board you and additional fees may be incurred in order to modify your

reservation.

Most of your time during this Mission Trip will be spent at high altitudes, and by completing this

application, you attest to the fact that you are in good health, with no medical conditions that

could compromise your well‐being or the well‐being of the mission team.

In case-of-emergency please provide us with name(s) and telephone number(s) of your

Emergency Contact(s) and indicate their relation to you:

1) ___________________________________________________________________________

2) ____________________________________________________________________________

Please state any further medical issues we should be aware of: i.e.: Allergies, special food

needs or other considerations, blood type, depression)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please state any comments or concerns you may have:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Vaccinations Make sure you are up-to-date on routine vaccines before every trip. We recommend getting the follow immunizations:

• Hepatitis A and B series is recommended

• TDaP (Tetanus, Diphtheria, Pertussis) The Amazonas Region is not an endemic zone for Yellow Fever. However, if you prefer you should get this immunization as well as any additional vaccinations recommended by the CDC guidelines state for traveling to Peru. (Check CDC recommendations at: http://wwwnc.cdc.gov/travel/)

http://wwwnc.cdc.gov/travel/


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What to expect in Chachapoyas - Amazonas Current Conditions On-Site at “Hospital Virgen de Fatima” (HVF) In many ways, HVF is similar to any county hospital in the US. We see patients with a variety of emergent, routine, and chronic conditions. Our volunteers and local staff aim to provide the highest quality care using the resources available and the policies adopted by the hospital. You will be practicing as part of a team of caregivers, within the practice/specialization area for which you are licensed and trained. However, several dimensions of the experience will likely be new to you. Be prepared to adapt to things that are different from your experience working at home. This includes resource limitations, language barriers, cultural differences, variance in provider training and experience, antiquated attitudes and traditional beliefs about medications and health, as well as the role of patients’ family members in the hospital setting. Conditions are sometimes crowded, confusing and loud. Shifts are long and can be physically and mentally demanding. Notwithstanding, many of those who have participated have described the experience as inspirational and deeply rewarding and have even returned to volunteer multiple times. Many participants are overwhelmed with the poverty and living conditions they see on the mission trip. Therefore, the mental preparation of participants through pictures, videos, testimonies, and dialogue is very important. In addition to the basic intellectual preparation, we encourage all participants to rely on the reinforcement that the work we do, causes a ripple effect in the grand scheme of things and DOES indeed make a huge difference. All participants are asked to adhere to appropriate social norms and respect as a visitor in a foreign country. The mission trip is not a place for excessive use of alcohol, sexual impropriety, and judgment of the culture or people. (See Appendix B) Keep in mind that public displays of affection are frequently an offense to certain cultures and must be limited to an appropriate and reserved touch. All participants commit to act with honesty, selflessness, integrity, and flexibility. All participants further commit to do their very best using their powers and all the talents and skills they possess accordingly in every circumstance while on the mission trip.


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CONSENT TO THE USE OF IMAGES AND VOICE/AUDIO

RECORDINGS

I, __________________________________________________________________ hereby give

(Christian Life Movement, Club Amazonas USA and its related entities/affiliates) permission to

freely use any pictures, recordings and/or videos which are taken by myself or in which I appear,

throughout any media or social media outlet in existence or to be created that are taken or

recorded in preparation for, throughout the duration of, and returning from the “VII International

Medical Mission – Amazonas 2019” mission trip.

_____________________________ ___________________________

Signature Date


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Assumption of Risks, Responsibility, and Liability Waiver

I, ____________________________________________, with Passport # _________________,

hereby declare my intention to participate in this VII Medical Mission to Amazonas, Peru – 2019.

I understand that my participation in the “VII Mision Medica Internacional Amazonas 2019”

mission trip will take me away from home for an extended period of time. During this period, I

understand that I will be in unfamiliar surroundings and will be exposed to risks to my person and

possessions. I understand that I may suffer personal injury, sickness, death, or damage to my

belongings as a result of my participation in this program. I, freely and of my own accord/volition,

being of sound mind, do accept and assume responsibility for all such risks, dangers and hazards.

Accordingly, I understand that despite its best efforts the Christian Life Movement, Medical

Missions to Peru, Solidaridad en Marcha, Club Amazonas-USA, and any of the “VII Mision Medica

Internacional Amazonas 2019” Organizers or their affiliates may not be able to ensure my

complete safety at all times from such risks and dangers.

Assumption of Responsibility: I understand that it is my responsibility to abide by all applicable

Amazonas Mission’s Organizers, partner or affiliated institutions, and host institutions’ policies

and regulations, and to ensure that I have adequate medical and travel insurance or health care

coverage, as well as protection of my personal possessions. More particularly, I understand that

the Amazonas Mission’s Organizers do not have to carry accident or injury insurance for my

benefit. Additionally, I understand that there may be certain circumstances for which I may

personally be held at fault if the accompanying conditions do not relate or arise from my mission

duties or if my activities or conduct fall short of what would be considered a reasonable

expectation for an individual in my position. I further acknowledge that I must be aware of and

abide by the accepted cultural norms, and standards of appropriate behavior in the locations

where I will be staying or visiting during the mission trip. In addition, I recognize that

inappropriate conduct may result in disciplinary action or termination of my involvement in the

above-mentioned program, at the discretion of the Amazonas Mission’s Organizers or the host

institutions. I agree to be accountable in all respects for my own actions and not to expect the

Amazonas Mission’s Organizers, or its directors, employees or volunteers to accept the

consequences thereof. Furthermore, I agree to be responsible for any claims made against the

Amazonas Mission’s Organizers or its directors, in relation to any such actions.


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I acknowledge that I have been advised by the CAUSA - Amazonas Mission’s Organizers, of such

risks and dangers as well as the need to act in a responsible manner at all times. My signature

below is given freely in order to indicate my understanding of the acceptance of these terms and

in consideration for being permitted by the Amazonas Mission’s Organizers to participate in the

above-mentioned Mission to the Amazonas Region in Peru. I recognize that the Amazonas

Mission’s Organizers will not supervise any other programs, living arrangements, or other

activities with exception of the direct ones stated above. I further acknowledge that I am of legal

age and will inform myself of, and abide by, the legal age limits, laws, and regulations for all other

jurisdictions where the activity or program occurs.

LIABILITY WAIVER: I RELEASE AND HOLD HARMLESS CHRISTIAN LIFE MOVEMENT (CLM),

MEDICAL MISSIONS TO PERU, SOLIDARITY EXPERIENCES ABROAD, SOLIDARIDAD EN MARCHA,

CLUB AMAZONAS-USA, ITS DIRECTORS, EMPLOYEES, ANY OF ITS AFFILIATES, AND ITS AGENTS

FROM ANY AND ALL LIABILITY. ALSO, FOR ANY LOSS, DAMAGE, INJURY, OR EXPENSE THAT MY

NEXT OF KIN OR I MAY SUFFER AS A RESULT OF MY PARTICIPATION IN THIS PROGRAM,

INCLUDING, BUT NOT LIMITED TO, ACCIDENTS, ACTS OF GOD, CIVIL WAR UNREST, SICKNESS,

TRANSPORTATION, SCHEDULING, GOVERNMENT RESTRICTIONS, OR REGULATIONS, AND ANY

AND ALL EXPENSES, WHICH MAY INCUR WHILE PARTICIPATING IN THE MEDICAL MISSION TO

CHACHAPOYAS -AMAZONAS, PERU 2017. THIS WAIVER IS EFFECTIVE FOR THE PERIOD OF TIME

THAT I WILL BE PARTICIPATING IN THE ABOVE-MENTIONED PROGRAM AND TRIPS RELATED

THEREWITH. I UNDERSTAND THAT THIS AGREEMENT CANNOT BE CHANGED OR MODIFIED

EXCEPT IN WRITING BY CLM OR CLUB AMAZONAS USA, AND THAT NO ORAL MODIFICATION OR

INTERPRETATION SHALL BE VALID. THIS AGREEMENT SHALL BE EFFECTIVE AND BINDING UPON

MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, AND ASSIGNS, IN THE EVENT OF DEATH.

If you have any questions or concern prior to signing this waiver, please consult your attorney.

I CERTIFY THAT I HAVE READ AND UNDERSTOOD THIS ASSUMPTION OF RISKS, RESPONSIBILITY,

AND LIABILITY WAIVER

_______________________ _______________________

Name: Date:


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Assumption of Risks, Responsibility, and Liability Waiver

MINOR CONSENT

I ________________________________, THE PARENT OR LEGAL GUARDIAN OF

___________________________ “PARTICIPANT” HEREBY RELEASES, FOREVER DISCHARGES,

AND AGREES TO HOLD THE CHRISTIAN LIFE MOVEMENT, MEDICAL MISSIONS TO PERU,

SOLIDARITY EXPERIENCES ABROAD, SOLIDARIDAD EN MARCHA, CLUB AMAZONAS USA, ANY OF

ITS AFFILIATES, ITS DIRECTORS, EMPLOYEES AND ALL VOLUNTEERS, HARMLESS FROM AND

AGAINST ANY AND ALL LIABILITY, CLAIMS, DEMANDS, LAWSUITS. AS WELL ANY EXPENSES

ARISING FROM PERSONAL INJURY, SICKNESS, DEATH, OR PROPERTY DAMAGE OF ANY NATURE

WHATSOEVER WHICH MAY BE INCURRED OR SUFFERED BY THE UNDERSIGNED AND OR THE

PARTICIPANT, WHILE ATTENDING THE (VII MISION MEDICA INTERNACIONAL AMAZONAS

2019) FURTHERMORE, THE UNDERSIGNED HEREBY ASSUMES ALL RISKS OF PERSONAL INJURY,

SICKNESS, DEATH, DAMAGES AND EXPENSES ARISING FROM THE UNDERSIGNED'S OR

PARTICIPANT'S PARTICIPATION IN ALL ACTIVITIES, INCLUDING RECREATION AND WORK

ACTIVITIES INVOLVED IN THE ABOVE ACTIVITY. IN ADDITION, AUTHORIZATION AND

PERMISSION IS HEREBY GIVEN TO FURNISH ALL NECESSARY TRANSPORTATION, FOOD, AND

LODGING FOR THE UNDERSIGNED OR PARTICIPANT.

I also give my permission for use of any photos taken throughout the course of the program for

its future publicity.

If Participant is under 18 years of age:

We (I) are the parents(s) or legal guardian(s) of the Participant, and hereby grant permission for

____________ to participate fully in the

above activity and all of its undertakings, and one or both of us will go with the minor in the trip.

The Participant will be notified ahead of time of the schedule and activities on the mission and

he/she will be responsible to participate in some or all of them. However, if the Participant leaves

the mission group at any time, day or night, the Participant will have taken extra and unnecessary

risks not contemplated in the original plan. This behavior is not recommended, and it will be

considered disruptive for the well-being of the mission group.

If the Participant wants to arrive to Peru earlier or stay longer after the mission for tourism or

other reasons, the Participant is responsible for making their own travel arrangements and the

Participant will be responsible for their own security, expenses, and risks taken.


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Furthermore, should it be necessary for the Participant to return home due to medical reasons,

disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. I also

confirm that my health insurance will cover me in case of sickness in Peru or I will purchase travel

insurance for that purpose.

If Participant is under 18, both parents (and custodial parent), or legal guardian must sign.

Participant's Signature: Date:

Phone: (day) (evening)

Documents

VII Misión Médica Internacional Amazonas 2019 · VII Misión Médica Internacional – Amazonas 2019 “UNIDOS POR UNA MISMA CAUSA” Sponsored by Christian Life Movement (CLM)