Rwanda Vision Trip
Please note that we will begin to process applications for the 2020 Vision Trip in early July 2019.

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 of $1,000 to the team fund by October 15th. The second contribution of $2,000 is due by November 1st. The final contribution of $1,500 is due by December 1st.

Personal Information
First Name *
Your answer
Last Name *
Your answer
Birth date *
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DD
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YYYY
Address *
Your answer
City *
Your answer
Province/State *
Postal Code *
Your answer
Phone #1 *
Your answer
Phone #2
Your answer
Email *
Your answer
Tell us about yourself and why you want to come on the Vision Trip. *
Your answer
Passport Information
Name as it appears on your Passport *
Your answer
Passport Number *
Your answer
Passport Expiry Date *
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DD
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YYYY
Citizenship *
Your answer
Emergency Contact Information
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
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.
Your answer
Allergies
Your answer
Current Medications
Your answer
Dietary Restrictions
Your answer
Program Contribution
Once your application has been approved, you will be required to send in a scan of your passport and a program contribution of $1,000 to the team fund by October 15th. The second contribution of $2,000 is due by November 1st. The final contribution of $1,500 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.