LTCare Ministries

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Medical Information & Waiver

Liability & Medical Treatment Release Form

  • Please use the name that is on your passport.
  • Date Format: MM slash DD slash YYYY
  • Date Format: 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.
  • Date Format: MM slash DD slash YYYY
  • For minors
  • Date Format: MM slash DD slash YYYY
  • Emergency Contacts

  • NameDosageCondition/ Reason 
  • Date Format: MM slash DD slash YYYY

Support Our Ministry

By His grace we are empowering the Body of Christ in North America and indigenous believers in Honduras and Central America to serve the needy and poor of their countries.
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Food For Thought

"In answer to your inquiry, I consider that the chief dangers which confront the coming century will be religion without the Holy Ghost, Christianity without Christ, forgiveness without repentance, salvation without regeneration, politics without God, and heaven without hell."
William Booth (founder Salvation Army)

Bread For Life

"Let not mercy and truth forsake thee: bind them about thy neck; write them upon the table of thine heart."
Proverbs 3:3

Contact

Love Truth Care Ministries
P.O. Box 164660
Little Rock, AR 72216
Phone: 501-374-8477
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