Age

Primary Phone Number

Address

City

State

Zip Code

Gender

Date of Birth

T-Shirt Size

Facebook/Instagram

Name of Home Church

Church membership

Pastor's Name

Emergency Contact #1

Emergency Contact #2

Email Address

Brief Statement of your Testimony

Do you have a Passport?

Passport Number

Passport Country of Issue

Dates of Mission Trip

PLEASE PLACE THE DATES YOU ARE GOING IN THE BOX BELOW

Have you been on a mission trip before?

If Yes, where did you go?

Parent or Guardian of Applicant (If under 18 years old)

I Grant Permission (Place Name of Applicant Below)

Permission Signature

Behavior and Conduct Contract

I, the undersigned, agree (if accepted for the mission trip) to adhere to all policies of Open Hearts Ministries. I agree to follow all guidelines set forth by the ministry for dress code and integrity. I acknowledge that if I fail to do so, there will be consequences for these decisions that may result in termination of my mission trip with Open Hearts Ministries. Termination of mission trip will result in immediate dismissal at which time I will return to the United States with no refund of any part of the cost of Mission Trip. Open Heart Ministries does not provide insurance of any kind for travel to Nicaragua. This includes health insurance, and/or travelers insurance. Each traveler is responsible for determining the level and type of coverage needed for their travel and stay in Nicaragua. Traveler’s Statement: I know it is my responsibility to determine if any insurance is needed for my travel to Nicaragua. I hold Open Heart Ministries any affiliates, board members, officers, employees, and volunteers harmless due to any loss or illness that could occur while traveling to, during my stay or traveling from Nicaragua.

Mission Trip Application-Nicaragua