Simone's Kids Trip Application
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We require all visitors to be a part of The Village, are you currently a Village member? *
What is todays date?
Legal Name (as shown on passport) *
If you are on Facebook, enter your profile URL
Mailing Address (street, cite, state, postal code) *
Current Home Address (if different)
Phone Number *
Email *
Gender *
Date of Birth *
Marital Status *
Passport Number *
Passport Expiration *
Medical and Emergency Contact Information
Who should we contact in case of an emergency? *
Emergency Contact Phone Number *
The Uganda Embassy requires that everyone who obtains a visa must have a Yellow Fever vaccination or a letter from their physician stating why they cannot receive it. Do you understand this requirement? *
How would you describe the condition of your health? Are there any health or emotional issues that might be important for us to know? *
Please list any medications you are currently taking: *
Please list any physical or emotional struggles that might affect you on this trip: *
Spiritual/Church Information
Please describe your relationship with Jesus: *
Please list any areas of ministry in which you have been involved (i.e. children's ministry, pastoral ministry, youth ministry, worship, etc.): *
General Questions
How did you hear about Simone’s Kids? *
Why do you want to be a part of the Simone’s Kids team in Uganda? *
What do you feel you can contribute to overall purpose of the trip? *
Have you ever been a part of an overseas mission trip before? If so, please tell us where you went and what your experience was like.
Are you willing to serve where needed while on this trip, follow the leading and direction of the designated Simone’s Kids team leaders, and submit to the decisions and direction that they feel necessary while in Uganda? *
Please list any special skills that you possess that might be of use during this trip to Uganda? (i.e. construction, teaching, children’s ministry, artistic, medical/nursing, drama, etc.). Please provide context for any listed skills.
Please read and confirm: I have answered these questions honestly and to the best of my ability. I understand I must be 18 years old, unless accompanied by a guardian. I understand that my $50 deposit is due with this application and that it is nonrefundable. If chosen for the trip it will go towards my trip cost. I understand all payments made towards my trip are nonrefundable. I understand that Simone’s Kids will review this application and may schedule a personal or phone interview for follow up questions. Please mail your deposit to Simone’s Kids, 200 West Main Street, Cartersville GA 30210 or scan the QR cods & donate online and add a special note. *
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