2026 Liberty Christian Church Youth Mission Trip Information & Consent Form - Adult

This form collects important information for the upcoming LCC mission trip. Your responses will help our team provide safe, thoughtful, and well-prepared care for all students and participants during the trip.
Trip Information:
Destination: Western Kentucky (Melber, Paducah, and Mayfield areas)
Dates: Sunday, June 28, 2026 – Friday, July 3, 2026
Transportation: Rented 15-passenger vans
Confidentiality Statement:
All information provided will be kept confidential by the Pastor of Family Ministry, Kelly Schneikart, and will only be shared with Liberty Christian Church (LCC) volunteers on a need-to-know basis to ensure the safety and care of your child.

Designated Staff and Volunteers:
The following individuals are designated as Liberty Christian Church (LCC) staff and volunteers for this mission trip:


Staff: Kelly Schneikart, Pastor of Family Ministry
Volunteers: Audrey Culver, Kate Grundy, David Hite, Liz Hite, and Kellen Laws

Adult Volunteer Information
 
 
 
 
 
Medical Information
 
 
 
 
Emergency Contact
Please provide at least one emergency contact who can be reached in the event of an emergency. 
 
 
 
 
Liability Release & Hold Harmless
I, the undersigned participant, hereby consent to my participation in this mission trip. I agree to hold Liberty Christian Church (LCC), its staff, and volunteers harmless from any and all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and any expenses of any nature whatsoever that I may incur during the trip, including all travel and transportation to and from the trip locations.
Please select all that apply.
 
Please select one option.

Description

This form collects important information for the upcoming LCC mission trip. Your responses will help our team provide safe, thoughtful, and well-prepared care for all students and participants during the trip.