Apply – H2Jamaica

Apply to join us on a mission trip

Full Name *

First

Middle

Last

Street Address *

City. State, Zip *

Home Phone *

Cell Phone

Email *

Preferred Communication Method

Home Phone
Cell Phone
Email

Birthdate *

Age *

Gender *

Male
Female

Do you have a Passport? *

Yes
No

Passport Number *

Preferred Name for Name Tag *

Emergency U. S. Contact During Trip *

First

Middle

Last

Emergency Contact Relationship *

Emergency Contact Home Phone *

Emergency Contact Cell Phone

Emergency Contact Email

Please indicate your general health: *

Excellent
Good
Average
Poor

Do you have any concerns about special needs (diet, lodging, lifting, stair-climbing)?

Have you recieved a COVID-19 Vaccine?

Yes
No
Not Yet

Specify any allergies you have marked above.

Do you have any other medical condition of which we should be aware? Is there anything that would limit your ability to walk on uneven ground, work outside, or work for 8 hours in a row?

Church Name *

How active are you in your church? *

Why do you want to come on this trip? *

Have you ever been on any other mission trip? *

Yes
No

If yes, where and when?

I am applying for: *

One-Week Option (8-day trip)
Extended Option (13-day trip)

I understand that information will be sent out by email (and I promise to read my email) unless I check the following box:

I do not have email and would like all information sent via U. S. Mail.

Typing your full name in this field will be accepted as your electronic signature. *

Date of Signature *

Signature of parent if participant is a minor:

Date of Parental Signature

Comment or Message *

Name