MDM Honduras

Transforming Lives… One Child, One Family, One Community At A Time

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Medical Information & Waiver

Liability & Medical Treatment Release Form

  • Please use the name that is on your passport.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • I do certify that I will be traveling to Honduras, Central America, to participate in the Tegucigalpa and San Matias, LTCare Ministries, Ministries of Divine Mercy (MDM Honduras) & Operation New Life outreach. I hereby release LTCare Ministries, Ministries of Divine Mercy (MDM Honduras), Operation New Life, DIME Hospital, and Hospital Escuela and their appointed agents, and any other hospital or ministry worksites, from any and all liability as a result of any accident, sickness or death that I may incur while participating in this outreach. Furthermore, I authorize the leadership of Love Truth Care Ministries, Ministries of Divine Mercy (MDM Honduras) & Operation New Life to take me to a doctor for medical treatment, emergency surgery and/or hospitalization should the need arise. I assume total responsibility for payment of all bills associated with the above-mentioned medical attention.
  • Note: U.S. Medical Insurance does NOT typically cover you outside of the U.S.A.
  • Finally, should it be necessary for me to return to the United States for any reason prior to the established return dates, I assume total responsibility for payment of all associated transportation costs.
  • As shown on passport.
  • MM slash DD slash YYYY
  • For minors
  • MM slash DD slash YYYY
  • Emergency Contacts

  • NameDosageCondition/ Reason 
  • MM slash DD slash YYYY

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Latest News

  • The Excitement Starts Before Kickoff
  • MDM May Update
  • MDM April Update
  • MDM Leadership Team Update #13
  • MDM Leadership Team Update #12
  • MDM Leadership Team Update #11

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MDM Honduras depends on your generosity to deliver the message of hope and empower the community in making godly choices. We can’t do this work without you. Join our community of donors; become one today!
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Recent Blog Posts

  • The Excitement Starts Before Kickoff
  • MDM May Update
  • MDM April Update

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Contact

MDM Honduras
P.O. Box 241485
Little Rock, AR 72223
(501) 765-8477

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