Student's Name *

First Name

Last Name

Student's Birth date

MM

DD

YYYY

Current Grade

8

9

10

11

12

Leader

Guardian Name *

First Name

Last Name

Emergency Contact (if different than guardian)

First Name

Last Name

Cost and pre-trip responsibilities *

By checking this box you are NOT agreeing to pay for the trip. You are acknowledging that you understand the cost and deadline for the trip.

I acknowledge the cost of the trip is roughly $800.00 for the mission trip. This includes all meals and activities during the trip, but not extra spending money. Although there will be opportunities for support raising and scholarships, there may still be a balance due for the trip. The deadline for the remaining balance in full is June 1, 2023. I also will be at the training meetings.