Chiapas Travel Application Form

Thank you for your interest in joining one of our delegations to Chiapas, Mexico!

“There are few opportunities where I am able to take a trip like this. By visiting and interacting with the Tseltal people, families, and communities, my life is enriched. I gain a deeper appreciation of the goodness and strength of their human spirit and learn about their rich culture, despite the many challenges they have faced over the years, including social isolation and poverty.” Jim Harms, Chiapas Delegate

To be eligible to travel with us, you will need to complete, sign and submit three things: (1) Travel Application; (2) Waiver of Liability and Assumption of Risk; (3) Security Guidelines and Safety Tips.

(1) Travel Application

You can two options. You can can download and complete a Travel Application and submit it by regular mail OR fill out an application online (below).

(2) Waiver of Liability and (3) Assumption of Risk and Security Guidelines. You must download and complete a Waiver of Liability & Assumption of Risk Form & Security Guidelines to complete your application.

To complete an online application, please provide us with the following information:

Contact Information

Your name (as it appears on your passport):

First Name

Last Name

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home Phone

Cell Phone

What is the best way to reach you?

Home Phone

Cell Phone

Traveller Information

Your date of birth:

(mm/dd/yyyy)

Do you have a US passport that will not expire within six months of our travel dates?

Yes

I have a passport issued from another country

If you have a passport issued by another country, please indicate which country:

Passport Number:

Expiration Date

(mm/dd/yyyy)

Emergency Contact Information

Name of Emergency Contact

First Name

Last Name

Their relationship to you:

Emergency Contact's Phone:

Emergency Contact's Alternate Phone:

Emergency Contact's Email

Verify Email

Emergency Contact's Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Interest in Travel to Chiapas

Please share what you hope to learn and what you're most interested in doing in Chiapas:

Please describe your history of involvement with One Equal Heart:

Please describe how previous travel experiences have helped to prepare you for traveling in Chiapas:

Please assess your Spanish-speaking skills:

None

Basic

Conversational

Fluent

Do you read and write in Spanish?

Yes, basically

Yes, fluently

Please assess your health and physical stamina:

Our Chiapas partners are located in an economically poor region where living conditions are simple. Our accommodations in Chiapas are shared and very simple. We often go on 1-2 day visits to outlying villages where conditions are primitive: sometimes no running water or toilet facilities; no refrigeration; basic diet of beans and tortillas; hot, humid days and sometimes cold nights; rough roads; sometimes long hikes; limited or nonexistent medical facilities; shared sleeping accommodations.

Are you taking any medications? If so, please give the name(s) and dosage(s).

*This information will be held confidentially by One Equal Heart and used only if you have a medical issue in Chiapas and notifying the treating health provider is advisable.

Are you under the care of a physician(s)? If so, please provide the physician(s)' name(s) and phone number(s) in case we have to contact them in the event of a health emergency in Chiapas.

Any dietary restrictions? Please describe:

Anything else you'd like to add?

Please upload your signed Waiver of Liability & Assumption of Risk and Security Guidlines

Please sign and upload in PDF form (either scanned or with an electronic signature). If you prefer, you can send these by mail.