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Simone's Kids Trip Application
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Email
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Your email
We require all visitors to be a part of The Village, are you currently a Village member?
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Yes, I give on a recurring bases to Simone's Kids
No, but I want to be- please tell me how!
No- I can't commit to something like that right now.
Other:
What is todays date?
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Legal Name (as shown on passport)
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Your answer
Nickname
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If you are on Facebook, enter your profile URL
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Mailing Address (street, cite, state, postal code)
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Your answer
Current Home Address (if different)
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Phone Number
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Email
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Your answer
Gender
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Your answer
Date of Birth
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YYYY
Marital Status
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Married
Single
Widowed
Divorced
Passport Number
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Passport Expiration
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DD
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YYYY
Medical and Emergency Contact Information
Who should we contact in case of an emergency?
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Your answer
Emergency Contact Phone Number
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Your answer
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?
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Yes
No
How would you describe the condition of your health? Are there any health or emotional issues that might be important for us to know?
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Your answer
Please list any medications you are currently taking:
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Please list any physical or emotional struggles that might affect you on this trip:
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Your answer
Spiritual/Church Information
Please describe your relationship with Jesus:
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Your answer
Please list any areas of ministry in which you have been involved (i.e. children's ministry, pastoral ministry, youth ministry, worship, etc.):
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Your answer
General Questions
How did you hear about Simone’s Kids?
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Your answer
Why do you want to go on a Simone's Kids Trip?
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Your answer
If wanting to attend a specific trip, please list below the dates and title of the trip you want to attend.
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Your answer
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.
Your answer
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?
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Yes
No
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.
Your answer
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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I understand and agree to these terms.
A copy of your responses will be emailed to the address you provided.
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