PID Service Trip Registration Form
Thank you for your interest in traveling with Partners In Development! You will help change lives in the developing world on your trip. The base price of the trip is $800 U.S. This price does not include airfare. (You will be informed of the airfare price once tickets are purchased. The cost of airline tickets varies depending on the time of year and location of travel. We do our best to find a good price.)

Trip Base Price includes (while in Haiti/Guatemala/Mississippi/Peru only):
-Lodging costs
-Three meals a day and clean drinking water
-Travel (health) Insurance for the duration of the trip
-Transportation costs
-First aid supplies (if needed; no prescription medication)
-Contribution toward the current PID project
-One cultural excursion

The base price does NOT include:
-Airfare
-Passport costs
-Immunizations
-Individual spending money or personal items related to trip
-Food/drinks/lodging or other expenses during travel to destination
-Snacks/drinks that are for sale
-Costs associated with missed, canceled or delayed flights and/or added days due to inclement weather

*Children ages 13-15 must travel to Guatemala, Mississippi or Peru with a parent.
*Children ages 16-17 traveling to Guatemala, Mississippi or Peru must be accompanied by a supervising adult with the permission of the parent.The supervising adult must be able to make arrangements in case of a cancelled flight or other unexpected circumstances.
*Children 13-17 traveling to Haiti must be accompanied by a parent.

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Partners In Development, Inc.
174 High street, Suite 106, Ipswich, MA 01938
978-380-6132
trips@pidonline.org

Partners In Development, Inc. is a registered 501(c)(3) non-profit organization.

Available Trips
Please note any specifications (medical, construction, designated for a specific school, etc.) for each trip.

Medical Teams: Medical, Dental, Counseling, Midwife, Eye and other Medical Professionals.

MEDICAL ALERT FOR PREGNANT WOMEN - If you are planning to travel to Haiti or Guatemala, and are pregnant or planning to be, please check with your doctor as to current Zika virus warnings. SELECT DATE OF TRIP (below) *
Trip Types: M = Medical | D = Dental | CO = Construction | CH = Childrens Program
Or, do you want to arrange your own trip dates for your group?
Enter Dates & Location (Haiti, Guatemala, Mississippi or Peru)
Your answer
Airport you want to DEPART from: *
Your answer
I am traveling as an: *
Group Name:
Your answer
Group Coordinator
The contact person for the Group you are travelling with
Your answer
How will you be paying your trip deposit? *
Mail check to: 174 High street, Suite 106, Ipswich, MA 01938.
Do you sponsor a child at the PID location you are going on a trip to? *
Personal Information
Full Name (as it appears on passport or ID) *
NO EXCEPTIONS -- NO NICKNAMES
Your answer
Passport/ ID Expiration Date *
Passports expiring within 6 months of travel may cause problems. Renewal is recommended.
Your answer
Passport Issuing Country
ex: USA
Your answer
Date of Birth *
MM/DD/YYYY
Your answer
Full Mailing Address *
Street, City, State, ZIP
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Gender *
Are you a licensed medical professional? *
Copy of medical license required (email, mail, or fax to PID's office)
Medical license expiration date
MM
/
DD
/
YYYY
If yes, what is your medical specialty? Please give detail. (If not a medical professional, enter "n/a") *
Your answer
If you are NOT a medical professional, what applicable skills do you bring?
Your answer
Please briefly describe any previous mission work and/or applicable travel experiences:
Your answer
What language(s) do you speak? *
Your answer
Do you have any medical conditions or special dietary requirements that PID should be aware of? (We do not guarantee accomodation for dietary needs. Please call for more info.) *
If yes, please elaborate.
Your answer
Emergency Contact Information
PID requires all volunteers have an emergency contact on file. We also recommend you leave a copy of your passport or legal ID with your emergency contact.
Emergency Contact *
Your answer
Emergency Contact's Relationship to You *
Your answer
Emergency Contact's Address *
Your answer
Emergency Contact's Phone Number *
Your answer
Emergency Contact's Email Address *
Your answer
Trip Agreement Contract & Waiver
I affirm that I have read and agree to the terms and conditions of this agreement.*
*Available at
https://static1.squarespace.com/static/5c6c5feeaadd340d884921bb/t/5cd1d5d2ec212d216508128e/1557255635072/2019+Trip+Agreement+%26+Waiver.pdf
Waiver Agreement *
Required
What to Expect Next
You will receive an email from our Trip Coordinators within 7-10 days of filling out this form. This will include important information about your upcoming trip. Please add trips@pidonline.org to your safe senders list.
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