FUMC Loveland and Longs Peak UMC

Feb. 3, 2023 - Feb. 12, 2023

Trip Application    
> Complete a separate form for each applicant.  Required fields are in blue.

1. General Information

First Name:   
Last Name:   
Birth Date:   
(month/day/year)
Gender:   
Email:     
Verify Email:     
Phone (home):   
Phone (mobile):  
Address:   
City:   
State:   
Zip:   

2. Flight Information

Handle my flight arrangements as follows:

 (Note that your ticket will be less flexible for changes)
Departure City:   
(U.S. departure airport)
 Frequent Flier #:

(United Airlines)
I have a current passport:
Passport Issued by:  
 
EXACT name on passport:   
 Expires:  
(month/day/year)
 Passport #:   
 
 
3. Personal Details
Dietary Restrictions; known allergies  
Roommate request:  
Single room (extra cost):
Medical Qualifications (MD, RN, EMT, CPR, etc.):
Spanish language skills:  
Notes: 
Use 'Notes' field to advise of:
- medical conditions
- travel dates differing from the group
- anything else that trip organizers should know
Skills: 

4. Trip Payment Details

Who will be paying for your trip?      
  
    
    
  
 
  
  
  
  

5. Emergency Contact
(not traveling with the group)
Full Name:   
Relationship:   
Phone (main):   
Phone (other):  

6. Agreement

We will be guests in Guatemala. We need to accommodate cultural expectations and represent our country in a way that helps build bridges. To that end, we have established the following agreement to be signed by all team members.

Team members agree to:

- Abide by rules outlined in the Special Requirements for Guatemala team members during COVID-19 pandemic  document.
- Be flexible!
- Be respectful of the local culture, and each other.
- Cooperate at all times with the team leaders concerning our life together, including daily assignments, food, lodging, transportation, and itinerary.
- Stay with the team from beginning to end.
- Abstain from the use of alcohol and tobacco while on the working portion of this trip. This means beer, wine, liquor, cigarettes, cigars, etc. The working portion of the trip starts upon arrival at the airport in Guatemala City, and ends upon arrival in Antigua.
- Respect the local standards of modesty regarding personal attire. This means not wearing shorts, going sleeveless, or wearing clothes that expose undergarments.
- Respect the dignity of the local population by not giving away candy, money, clothes, etc.
- Abstain from forward behavior and/or romantic involvement with the local people we work with, and not to encourage such advances from others. Pura Vida may have to discontinue hiring of locals who become too aggressive with our teams.

Please respond:   


7. Liability release

I release and agree to hold harmless Pura Vida Ministries and any related agency, conference, district, local church, member, volunteer, employee, or agent, from any liability, injury, damages, loss, accidents, delay, or irregularity related to the undersigned individual’s planned participation or involvement in this work trip. 

I have been advised and understands that the project may involve unusual risks to participants.  Those risks may involve, among others, the following:

Accidents related to construction or other work; dangers resulting from disease including hepatitis, cholera, dysentery, malaria, dengue, Chagas disease, and other diseases; from unsanitary health conditions in camps and villages; from hazardous conditions and drivers on roadways; from civil insurrection or warfare; from terrorist, guerrilla, or criminal activities; from post-warfare hazards such as landmines; from geographic features such as high altitude, which may have a deleterious effect on persons with heart conditions or respiratory diseases; from extreme heat and humidity with no air conditioning available, or from extreme cold with no central heating; from inadequate road conditions and unsafe driving practices common in Third World countries. The foregoing is not an exhaustive list of dangers that may arise but is illustrative of some types of dangers that may be faced.

This release covers all rights and actions of every kind, nature, and description, which the undersigned ever had, now has, or but for this release, may have. This release binds the undersigned and his or her heirs, representatives, and assignees.
Please respond:   

Signature:   

(Type full name)

8. Photo release

I authorize Pura Vida Ministries to use the following personal information:

(1) My picture, including photographic, motion picture, and electronic (video) images.

(2) My voice, including sound and video recordings.

For good and valuable consideration I give my permission to Pura Vida Ministries (PV), to use my name, photograph, video/film footage, voice recording and/or likeness thereof recorded (“materials”) for the purposes of public relations, public awareness or education, public service and/or fundraising, including social media sites including, but not limited to, Flickr, Facebook, and Instagram. This includes occasional granting of permission to outside organizations, for use of the materials in support of PV ministry objectives. I hereby hold harmless PV, and all its affiliated organizations, from any liability for use of my image or likeness, both visually and audibly. I agree that PV has unlimited use of my image or likeness, both visually and audibly for the purposes described above, without additional remuneration beyond that, if any, which has been agreed upon this day.
Please respond:   
Signature:   

(Type full name)