Rwanda Vision Trip
Please complete one application form per trip attendee by the application deadline.  Once your application has been approved, you will be required to send in a scan of your passport and an initial contribution of 50% or full payment by January 15th.

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Personal Information
First Name *
Last Name *
Birth date *
MM
/
DD
/
YYYY
Address *
City *
Province/State *
Postal Code *
Phone #1 *
Phone #2
Email *
Tell us about yourself and why you want to come on the Vision Trip. *
Passport Information
Name as it appears on your Passport
Passport Number
Passport Expiry Date
MM
/
DD
/
YYYY
Citizenship *
Emergency Contact Information
Emergency Contact *
Emergency Contact Phone *
Emergency Contact Relationship *
Medical & Dietary Conditions
Activity Restricting Conditions
Please note any limitations that would inhibit you from walking or sitting for extended periods of time, easily entering or exiting vehicles, or walking on uneven ground.
Allergies
Current Medications
Dietary Restrictions
Trip Payment
Once your application has been approved, you will be required to send in a scan of your passport and a payment.

Please visit https://thewellspringfoundation.org/trip/payment/ to make a secure contribution via credit card or bank account.
Cheques may be mailed to:

The Wellspring Foundation
PO Box 32112
Langley BC  V1M 2M3
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This form was created inside of The Wellspring Foundation for Education.