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Summer Intern Participant Release Form

The below form is to be submitted online after acceptance into the Summer Intern Program. A copy with original signature must also be submitted, but may be provided at the time of arrival. We ask that it be read and signed by parents of interns  whether or not they are minors.  Aside from the liability aspect, we want to ensure that parents understand and are supportive of their child's desire to serve as an intern. 

Liability Release Form

I understand that there are inevitable risks involved in any mission trip, and I hereby release Words To Works, its staff and volunteer workers from any and all liability due to injury, loss or damage to person or property that may occur during the course of the stay with Words To Works.

Agreement to Transport Home

I give consent for my child to attend Words To Works.  I understand that a member of the Words To Works staff may need to send a participant home as a result of illness or discipline problem.  I understand that if the participant is dismissed from the mission site, he/she will be transported home at my expense.  Words To Works will attempt to contact the parent or guardian to arrange such transportation.

Medical Release Form

I give my consent for my child to attend Words To Works.  In the event that he/she is injured while staying in Jacksonville and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician.  In the event treatment is called for, which a hospital will not administer without my consent, I hereby authorize a member of Words To Works to give such consent if I cannot be reached by telephone, or because of an emergency.  In the event it becomes necessary for that person to give consent for us, I hereby agree to hold that person and Words To Works free from any claims, demands or suit damages arising from the giving of such consent so long as the treatment is administered by a licensed medical office.  I also acknowledge that I am responsible for any and all costs of any treatment or care for my child.

By submitting this form, I am stating that I agree to all of the above listed about my child's stay.


    • Summer Intern Information

      The above releases apply to the following person:
    • Name *


    • Email *

    • Date Arriving *

    • Date Departing *

    • Parent's/Guardian's Information

    • Name *


    • Email *

    • Home Phone *

    • Cell Phone *

    • Address *








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