Rwanda Vision Trip
Please complete one application form per trip attendee. Once your application has been approved, you will be required to send in a scan of your passport and a program contribution to the team fund by October 15th. The second contribution is due by November 1st. The final contribution is due by December 1st.
Personal Information
First Name *
Last Name *
Birth date *
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DD
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YYYY
Address *
City *
Province/State *
Postal Code *
Phone #1 *
Phone #2
Email *
Tell us about yourself and why you want to come on the Vision Trip. *
Passport Information
Name as it appears on your Passport *
Passport Number *
Passport Expiry Date *
MM
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DD
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YYYY
Citizenship *
Emergency Contact Information
Emergency Contact *
Emergency Contact Phone *
Emergency Contact Relationship *
Medical & Dietary Conditions
Activity Restricting Conditions
Please note any limitations that would inhibit you from walking or sitting for extended periods of time, easily entering or exiting vehicles, or walking on uneven ground.
Allergies
Current Medications
Dietary Restrictions
Program Contribution
Once your application has been approved, you will be required to send in a scan of your passport and a program contribution to the team fund by October 15th. The second contribution is due by November 1st. The final contribution is due by December 1st. You may contribute on or before these dates, or all at once.

Please visit https://secure.thewellspringfoundation.org/give to make a secure contribution via credit card or bank account.
Cheques may be mailed to:

The Wellspring Foundation
PO Box 32112
Langley BC V1M 2M3
I will contribute by *
Pre/Post Vision Trip Travel Plans
If you are planning on visiting other places prior to, or after, the Vision Trip itinerary we will contact you for more information to aid in the booking of airline tickets.
Do you have pre and/or post vision trip travel plans? *
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This form was created inside of The Wellspring Foundation for Education.