Poetice

Poetice Trip Application

IDENTITY

* First Name

* Last Name

* Email

Preferred Name

* Address

* City

* State

* Postal Code

* Country

* Phone

* Gender

Please select your birthday from the date picker or manually format your birthday MM/DD/YYYY

* Birthday

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ADDITIONAL PERSONAL INFORMATION

* In two(2) sentences tell us about your relationship with Jesus.

* Please list any talents, abilities, jobs, giftings, preferences, etc that may be helpful on this trip.

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TRIP PREFERENCES

* What group are you applying with? Please type the full name of the church, school, etc. that you are traveling with. If you are traveling as an individual, please write 'individual'. Ex: Hope College, The Ransom Church, etc.

* What trip are you applying for?

* List two or more airports you would be willing to depart from. Please provide the airport names and 3 character codes like this: Grand Rapids (GRR), Detroit (DTW), Chicago Ohare (ORD)

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BASIC MEDICAL INFORMATION

While a complete physical is not required for participation in this trip, it is encouraged. It is our hope and your responsibility to ensure your own physical condition is satisfactory for participation in this trip.

I understand that it is solely my responsibility to complete a physical exam and or ensure that my physical condition is satisfactory for participation in this type of work.

* Please list any and all medical or dietary allergies, conditions, and or restrictions that you have. This would include vegetarian or gluten free, nut or penacilin allergy, etcetera. (If none, simply indicate "none")

* Please list any and all medications that you are currently taking and/or will be taking while on your trip. (If none, simply indicate "none")

* Please select your blood type

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UPLOADS

WAVIER & RELEASE FORM
Please upload a scan of your signed Wavier & Release Form (find link under DOWNLOADS section)

Waiver

PASSPORT
Please upload a photo of your passport. If you have not yet received your passport, please email it to trips@poetice.org as soon as possible. (*file must be less than 1MB in size)

Passport

* Please list your name as it appears on your passport.

* PASSPORT EXPIRATION DATE

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EMERGENCY CONTACT

* Emergency Contact

* Emergency Phone

* Emergency Contact Email Address

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AGREEMENTS & OBLIGATIONS

By submitting this application, I understand that upon review & acceptance, I am responsible for my airfare and trip cost as communicated to me by Poetice as well as obtaining a passport and necessary immunizations, completing a waiver release form, and adhering to Poetice deadlines.

I understand.

By submitting this application, I understand that, if I do not raise and submit the necessary funds by the final due date, my flight will be cancelled and I will not be able to participate in the program.

I understand and agree to these terms.

By submitting this application, I understand that, should I need to withdraw from this trip for any reason, I am still responsible for any expenses that have already been incurred on my behalf by the date of my withdrawal and that, because funds can not be returned for any reason, any remaining funds that were donated on my behalf will be disbursed to other trip participants and/or programs at the discretion of Poetice within Poetice's current fiscal year.

I understand and agree to fully follow through on my commitment.

By submitting this application, I understand that that all donations that are given to Poetice by me or on my behalf can NOT be returned in any form for any reason. In the event that I raise more than is necessary to fully cover the cost of my own trip, funds will be dispersed to other trip participants and/or programs at the discretion of Poetice within Poetice's current fiscal year.

I agree.

Confirmation of identity and providing truthful information.

I confirm that I am filling this application out for myself, not for someone else. AND THAT all information I have provided on this form is correct to the best of my knowledge.

IMPORTANT INFORMATION

Please keep in mind that you cannot save this application once you start it, so be sure to complete and scan any necessary uploads prior to starting your application.

WAVIER & RELEASE FORM - In order to submit this form, you must upload a completed Waiver & Release Form (download wavier form below).

PASSPORT - If you have a passport, please upload it. If you have not yet received your passport, please upload a copy of your passport to https://poetice.kindful.com/register/documents as soon as possible.

IMMUNIZATION RECORD

Please visit the Center for Disease Control (CDC) website to review all recommended immunizations for the country you intend to travel to. VISIT THE CDC TRAVEL SITE NOW