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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