Participant Information
Our large team trip to San Luis Rio Colorado, Mexico, is this coming Spring Break 2017. We will join brothers and sisters from Nueva Esperanza to build homes and help with a vacation Bible school / day camp for children in the surrounding neighborhoods.
Participant First Name
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Participant Last Name
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Age
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Gender (for housing purposes)
Birthdate (MM/DD/YYYY)
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Participant Email Address
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Confirm Email Address
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Parent/Guardian Full Name
All applicants, age 18 or younger, must provide contact information for a parent/guardian.
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Parent/Guardian Email Address
All applicants, age 18 or younger, must provide contact information for a parent/guardian.
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Confirm Email Address
All applicants, age 18 or younger, must provide contact information for a parent/guardian.
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Street Address
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City, State, Zip
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Participant Phone
If participant does not have his/her own cell phone number, please leave this space blank.
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Parent/Guardian Phone
All applicants, age 18 or younger, must provide contact information for a parent/guardian.
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T Shirt Size
Attendance at scheduled meetings is extremely important. Please select any dates below that you will have to miss and then make arrangements with a member of the leadership team.
Cost
We have set the price this year at $600/person or $1700 for a family of three plus $100 for each additional family member (4th, 5th, etc.).
Emergency Contact Full Name
At least one member of each family must provide information for an emergency contact.
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Relationship
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Emergency Contact Phone
At least one member of each family must provide information for an emergency contact.
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Date of Last Tetanus Shot (MM/YYYY)
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Physician
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Physician Phone
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Medical Insurance Provider
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Medical Insurance Policy Number
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Medical Insurance Identification Number
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Allerigies
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Food Sensitivities
Please describe the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability or condition to which you or your child is subject and of which the staff should be aware; any action of protection that may be necessary; necessary medications; reasons why your or your child's activities should be restricted; and any other special needs (including dietary). Please include any necessary narrative, clarification and/or documentation (or email it separately to ericmuhr@gmail.com):
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Each family has the responsibility of providing a tent (knowing that there is the possibility of damage and/or destruction). Do you already have a tent you can bring?
How many does it sleep comfortably?
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How might you and/or the members of your family cope with the stress of this experience? What extra help might you need in order to both survive this experience and grow as a result?
If you have children who are not yet in high school, you must have a care plan in place before we leave for Mexico. If both parents are coming to Mexico, which one will be your child's primary caregiver/supervisor during the trip? Who will be with your child if/when either parent is not? Has that person agreed to supervise and/or care for your child if/when a parent is not present? It is our expectation that children are supervised at all times. This supervision is crucial for your child's safety on the road, on the worksite, in a foreign country; and having a plan in place will make it easier for you to be an active contributor to our community and to the work.
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How flexible are you in foreign contexts? How do you feel about not knowing what the plan is or with things seeming to be disorganized, or illogical?
This trip requires that we live, interact, work, and worship with people we don't know very well. In some cases, because of differences of culture, of dress, of expectations, of language, we may find that it is difficult to connect and/or communicate with one another. At times, you may feel judged. Or uncomfortable. Or confused.
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How might you maintain a positive attitude in difficult working conditions? What kind of communication and/or support helps you to make it through difficult working conditions?
On the worksite, long periods of inaction can suddenly be broken by a need for everyone to jump in and work quickly to accomplish a task. This ebb and flow of work can lead to tension, raised volume, anxiety. Some people are energized by this kind of work. Others find that it makes them feel powerless or purposeless or like they're just in the way.
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How can you take care of yourself and others in order to maintain your health?
On trips like this, people often get sick. Our experience suggests that there are several contributing factors -- foreign foods, not enough sleep, poor-quality sleep, heat exhaustion, dehydration, social stress, generalized anxiety, the pace of the work.
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Our work teams in Mexico will include families and a significant number of high school youth. IF YOU ARE AN ADULT: How might you be able to equip young people, to connect with them, to work alongside them, to help them?
We are taking a community of people the size of a small church down to Mexico. That community includes young and old, skilled and unskilled, bilingual and English-only, and everything in between. Consider in your responses to the next few questions where you might fit in this community, what gifts you bring, and how your faith can make a difference, not just in the quality of your experience, but in how your involvement affects others in your tent, in your van, on your worksite, in the neighborhood ...
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Our work teams in Mexico will include families and a significant number of adults. IF YOU ARE A YOUTH: How might you be able to support adults, to connect with them, to work alongside them, to help them?
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What gifts, abilities, skills, experience, or knowledge do you bring to this trip? (We will use this information to assign you to a work team.)
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How might your Christian faith, your experience of Christian community, and/or your relationship with Jesus inform or otherwise affect your participation in this work trip?
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Occupation
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Drivers License #
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Do you currently have a CDL (commercial driver's license)?
In the past three years, have you been at fault for any accidents?
In the past three years, have you had any moving traffic violations?
In the past three years, have you had any insurance company cancel or refuse to provide you with auto insurance?
In the past three years, have you had your drivers license revoked, suspended or restricted?
In the past three years, have you had any physical impairment other than corrective glasses?
In the past three years, have you ever been charged with or convicted of "driving while intoxicated" or "driving under the influence"?
If the answer to any of the last six questions is "Yes," please explain:
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Full Name
First Middle Last
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Maiden Name (or other surnames by which you have been known)
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All states in which you have lived
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Have you been arrested for any reason?
Have you been convicted of or pleaded no contest to any crime?
Have you engaged in any child molestation, exploitation, or abuse?
Are you aware of anything about you that might pose a threat to youth?
Are you aware of any reason you should not work with youth?
If the answer to any of the above questions is "Yes," please explain:
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