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August 2026 Participant Information
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Email
*
Your email
Legal Name (First and Last)
*
Your answer
Address & Phone Number
*
Your answer
Please indicate which of the following most accurately describes you.
*
My heart is already there - I'm in, all the way.
I'm very interested but still testing the ground. I need more information.
I'd like to say I'm interested, but this probably isn't the trip for me.
Other:
Date of Birth
MM
/
DD
/
YYYY
Passport Status
I have a valid passport with an expiration date ON or AFTER June 30, 2027
I have applied for a passport, awaiting on arrival.
I do not have passport and have not applied.
Clear selection
*IF*
you have your passport, please provide the following:
Passport Number
Passport Date of Issue
Passport Date of Expiration
If you await your passport's arrival, please provide these to Shaye as soon as it arrives.
Your answer
Have you ever been convicted of a felony? If yes, please give short explanation. This will be required for our visa application.
Your answer
Emergency Contact (Name, relationship, phone number)
Your answer
Do you (or will you possibly) need a donation link and QR code to give to potential donors?
*
Yes (please check even if Shaye has already provided this for you)
No, I will use another method and send money onto Rehema Home.
You will be required to provide 2 things to Shaye for the visa application via email. Please make note of them below.
Selfie-type picture that is clear, without glasses and with good lighting.
A photograph or scan of your passport (picture page only). All 4 edges must be clear and not cut off by a scanner. If you take a picture, please do not cover anything with your finger.
Do you have any medical issues, concerns or even dietary restrictions that should be disclosed to the team leader? If yes, please explain.
*
Your answer
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