Caring Hearts Ministry · Short Term Missions Trip Application

Name

*

First Name

Last Name

Email

*

Verify Email

*

Phone

*

Birthdate

*

(mm/dd/yyyy)

Age

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Gender

Male

Female

Emergency Contact

*

First Name

Last Name

Emergency Contact Phone #

*

Home church name, city, and state

Why do you want to go on a trip with Caring Hearts Ministry?

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Trip name

*

Select the trip you are attending.

Trip Leader's Name

How did you hear about this trip?

*

Online

Friend/Family

Church

Event

Other

If you selected "other", please indicate how you heard about this trip.

Previous mission trip experience? If yes, briefly describe.

What special talents or gifts do you have to share?

*

Do you have any food allergies or sensitivities or other issues we should know about ahead of time so we can make proper preparations?

*

Do you speak Spanish?

*

No

A little

Fluently

Do you have a passport?

*

Yes

No

Place of employment

Job Title

If student, school:

What grade?

Trip Funds Requirements

I recognize that I am wholly and completely responsible to raise any and all funds necessary for the trip, including travel, room, and board, and all costs involved with the team's purpose/project. Funds payable directly to Caring Hearts Ministry will be submitted at least 3 weeks prior to departure. This can be done via the website at caringheartsmexico.org/pay for trip, or by mailing a check to Caring Hearts Ministry, PO Box 1620, Cranberry Twp, PA 16066. Make note of the date of your trip on the check.

I will complete an Assumption of Risk/Waiver of Liability Form and submit it at least 3 weeks prior to departure to Caring Hearts via this digital form.

CHM must be notified immediately of any cancellations.

I agree with the Trip Funds Requirement Statement

*

I agree

I disagree

Photograph Permission

Caring Hearts Ministry has my permission to share photographs of me that are taken during a missions trip on all Caring Hearts Ministry sites and social media.

I agree with the Photograph Permission Statement.

*

I agree

I disagree

Minors traveling without parents

The parents of all minors, if not accompanying their children, must sign a Caring Hearts Ministry Parent Release Form granting the group leader permission to take their child(ren) across the border. A parent must also sign the Assumption of Risk/Waiver of Liability Form.

Minors without parents

*

I am not a minor. This does not apply.

I am a minor traveling without a parent and will comply with supplying affidavit(s).

I am a minor traveling with a parent.