Please enable JavaScript in your browser to complete this form.About MeName *FirstLastAs it appears on your passportName for Name Tag *Preferred Pronouns *He/HimShe/HerThey/ThemGenderMaleFemaleTransNon binaryOtherEmail *Phone *DocumentationDate of Birth *Passport # *Expiration Date *Country of Issue *Congregational InvolvementChurch you attend or are a member *The support of your congregation is an important aspect of this experience. Please discuss your plan to participate with your pastor or mission committee. *Emergency Contact InformationEmergency Contact Name *FirstLastEmergency Contact Relationship * participate your will Emergency Contact AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact PhoneEmergency Contact Email *Medical InformationPlease indicate if any of the following applies: *Mobility IssuesAllergiesWill travel with CPAPImmunocompromising conditionsSeizure disorderSurgery with the last six monthsCardiovascular event within the last twelve monthsRespiratory illness within the last two months (including COVID)PregnantBreastfeedingChronic mental health conditionOtherNo medical concernsPLEASE NOTE: If you use medical marijuana on a regular basis, be advised that possession of marijuana is considered a crime in Guatemala. You will not be able to bring or use marijuana on a CEDEPCA trip.If any boxes were checked in the previous entry, please explain: Any dietary restrictions?Current medications and dosageQuestions For ConsiderationHave you ever traveled to Guatemala before? When and why?Why are you interested in going on this trip?How would you describe your Spanish skills?Native SpeakerFluent/BilingualProficientConversationalKnow a few wordsNone(no Spanish skills required for this trip)I will attend a required trip orientation, to be scheduled by the group YesNoAlternative Funding Sources MyselfMy ChurchMy Ministry GroupScholarship through the Guatemala PartnershipScholarship through the Robert J Turner Memorial FundScholarship through the Herbert D Valentine FundLinks for more infomation below this form.For Guatemala Partnership Scholarship ConsiderationPlease tell us what you understand the purpose of this trip to be and why you wish to be a part of this experience.After your return from the trip, in what ways do you intend to carry forward what you have learned?Sharing my experiences via a presentation to my mission committee and/or churchSharing the prayer letter and updates on Guatemala with my church and keeping CEDEPCA in my prayersParticipation in the work of the Guatemala PartnershipUsing what I have learned as part of my own ministryOtherPlease explainHow are you paying the deposit? *By Check in the mailOnline PaymentPlease follow instructions below this form.I acknowledge that I undertake this trip representing Christ, my church, and the Presbytery of Baltimore. I understand that this trip is intended to enrich me personally and spiritually and that it may also challenge me in unexpected ways. I agree to show respect to our Guatemalan partners, the Guatemalan people that I meet, and the Guatemalan culture I encounter. I will abide by trip guidelines, show courtesy to my fellow travelers, and fulfill my personal and financial obligations. *AgreeSubmit
