Short Term Service Trip Online Application Form

* Required Field

Trip date*

Church/Organization

Name exactly as it appears on your passport*

Name you preferred to be called*

Date of Birth*

Month
Day
Year

Gender*

Age*
If under 21, the notarized power of attorney form must also be completed

Shirt size*

Address*

City*

State*

Zip code*

Phone Number
Home
Work
Cell

Profession*

Email*

Do you speak Spanish

Special skills (i.e. construction, computer, musical, medical, etc.)

Special health concerns

Medicines currently taking

Special diet required

How did you hear about Montaña de Luz

Why do you want to participate in this experience

Emergency contact Name

Relationship

Phone Numbers
Daytime

I give permission for Montaña de Luz to use photographs of me taken on the trip for promotional use.
YesNo