Online Application to Costa Rica

Overview

Trip applicant name*

First Last

I am applying to go to...*

Costa Rica

Colombia

Name of the trip you are applying for*

Date of the trip you are applying for*

What airport will you be flying out of?*

Who are you traveling with?*

How did you hear about Corner of Love?*

Application Checklist

All items must be mailed to Corner of Love

Complete Mission Trip Application

Copy of Photo Page of Passport (Must have > 6 months validity)

Copy of Medical, Dental, or Professional license (if you are a licensed healthcare professional, not required if you are a general volunteer)

Copy of CV (Resume) if you are a licensed healthcare professional, not required if you are a general volunteer

Notarized Minor Consent Forms (if under 18 years & without a parent)

First Deposit of $825 if self-funding; $100 deposit if fundraising

Thoroughly read trip information on website www.corneroflove.org

Copy of flight itinerary (if you haven’t yet booked it you can turn in later)

NOTE: This checklist is not required to submit this application. It designed to help you gather every thing that you need to send in.

Cost information

Any team member may seek 100% tax-deductible contributions to fund their $1850 Costa Rica or $2650 Colombia trip fee. This means that any person attending a trip may solicit donations using our EIN number and people who support them will receive an end-of-year receipt for their tax-deductible contribution. Please call our office for assistance in setting up an online MightyCause fundraising page (mightycause.com/organization/Corner-Of-Love-Ministries) if needed.

Costa Rica Trip Cost:

$1850 due in US (can be fundraised using COL’s EIN number)
$100 envelope for Costa Rica spending money for tips/Left Right Center game/ice cream/treats in town (all optional).

Colombia Trip Cost:

$2650 due in US (can be fund-raised using COL’s EIN
$100 envelope for Costa Rica spending money for tips/Left Right Center game/ice cream/treats in town (all optional)

Personal Information

Name (as it appears on your passport)*

First Last

Occupation/area of study*

Passport number*

Issued by (country):*

Select

Date of birth*

Home address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone number

Cell phone number

May we text you? (Standard message rates apply)*

Yes

No

Email*

Enter Email Confirm Email

You will receive a copy of this application in your email after signing and submitting

Marital status

Name of Employer*

Work phone number

Have you ever been to Costa Rica?*

Yes

No

With what organization have you been to Costa Rica?*

Are you a student?*

Yes

No

Name of school*

List any groups you are member of such as Rotary, Boy Scouts, etc.:

List any boards that you serve on:

Do you attend a church?*

Yes

No

Name of church*

Name of Pastor*

Address of church*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position (volunteer or paid) at your church*

Emergency Contact

Spouse/Emergency contact name

First Last

Phone number of emergency contact

Email address of emergency contact

Social Media

May we follow you on Twitter, Instagram and/or Facebook?*

Yes

No

Medical & Diet Information

Do you have any health concerns?*

Yes

No

What is needed, or how do you keep yourself well?*

When was your last physical?*

Date of your last Tetanus shot*

If you are not sure, please enter "not sure."

Date of your last Hepatitis A Vaccine*

If you are not sure, please enter "not sure."

Do you have any allergies?*

Yes

No

Please list your allergies, and what you do or take to combat them*

Do you have any physical limitations?*

Yes

No

Please describe any physical limitations that you have*

Are you currently undergoing, or have undergone treatment for illnesses in the last 12 months?*

Yes

No

List any treatments you are currently undergoing or have undergone within the last 12 months*

Please describe your general health, and any other notes regarding your health that you would like to share*

What foods do you like to eat?*

Are there any foods you cannot eat?*

Please list all medications you are currently taking (If applicable)

Medication Name

Dosage

How long on medication

click the + button to add more rows

In the event of an emergency, I give permission to the leaders of the mission trip to seek medical treatment. The doctor or hospital has my permission to administer medical treatment.*

I agree

Out-of-country Medical Insurance

Corner of Love encourages you to consider purchasing out-of-country medical and evacuation insurance, which can be obtained through International Services of America (www.isabrokers.com) 800-647-4589 or other companies for approximately $30. Please forward insurance info to COL if you do opt to obtain coverage.

Travel Plans

Have you made your flight arrangements?*

Yes

No

Do you have any travel partner(s) that you prefer to room with while serving with Corner of Love?*

Yes

No

Please describe any special sleeping accommodations you have (If applicable)

Additional Information

Shirt size*

Please list previous overseas travel, places, and purpose of visit(s) (if applicable)

Country

Date

Purpose

What do you like to do in your free time?*

Do you anticipate any aspects of the trip being difficult for you?*

Yes

No

Please describe what you anticipate being difficult about the trip*

Do you have any worries/concerns about this trip?*

Yes

No

Please describe your worries/concerns*

What can we pray for on your behalf in the months leading up until the trip?

Please explain your interest in participating in this trip*

Please share your favorite bible verse or saying

Terms and Conditions

All payments, both for trips and donations are non-refundable.

Any team member may seek 100% tax-deductible contributions to fund their $1850 Costa Rica or $2650 Colombia trip fee. This means that any person attending a trip may solicit donations using our EIN number and people who support them will receive an end-of-year receipt for their tax-deductible contribution (mailed each January for the previous year). Tax-deductible donations to cover your $1850 Costa Rica or $2650 Colombia trip fee should be given directly to COL and never be held by an individual, church, or entity that does not distribute 100% of the money collected on your behalf.

100% of the trip costs should be paid at least 45 days prior to departure date, unless prior arrangements are made with Corner of Love Trip Coordinator.

All trip participants must be 18 years or older unless accompanied by a parent or other guardian. Permission to travel with a guardian other than a parent must be discussed with Corner of Love’s Director/Team Leader prior to completion of this application.

Corner of Love reserves the right to reschedule the trip, when extreme circumstances require.

In the event that a participant cannot go on a scheduled trip and has made partial or full payment, and/or if the participant raises funds in excess of the trip costs, the funds received by COL will go to support the Relief Center for Nicaraguan Refugees and/or other program costs as determined by COL.

Each participant must bring to Costa Rica/Colombia:

$100 envelope for Costa Rica spending money for tips/Left Right Center game/ice cream/treats in town (all optional)
$75-$100 for spending money
Items listed on the COL’s “What to Bring List”

Each participant must agree to submit to the leadership and authority of the in-country hosts and/or Leaders of Teams.

Any participant that engages in disrespectful or extremely difficult behavior, undermining in-country systems, or failure to comply with COL guidelines, privacy policy, treatment schedule, or other medical protocols will return to Liberia and finish their stay at an airport-area hotel at their own expense. All COL guidelines, policies, and treatment protocols may be requested at any time from info@corneroflove.org.

Each participant will be required to wear a COL provided t-shirt on given days. The trip coordinator will let you know which days will be required – do NOT wear on travel days.

Sharing our team’s efforts and stories with donors is important. By signing this application, you hereby give permission to COL to use your photograph(s) in newsletters, on our website, and/or other sites or materials UNLESS you provide a written request to us stating otherwise.

Each participant is encouraged to help raise funds for the team’s activities and the organization but this is not a requirement. We encourage use of online platforms such as mightycause.com or facebook. On all sites, Corner of Love should be chosen as the payee (EIN No. 36-4612230). Many team members pick a specific project to fundraise for above and beyond their own trip cost. Please visit our website or contact our office for more information on current fundraising projects. By signing this application, you understand that all donations should be mailed or given directly to COL and that contributions are 100% tax-deductible.

Each participant agrees to take two 50lb pieces of cargo luggage filled with mission supplies to Costa Rica/Colombia. In Washington state, cargo is inventoried and packed by COL, then assigned to travelers. Outside WA, COL staff or team leader instructs volunteers on how to pack donated items into two bins, donated suitcases, or duffel bags. Personal items are always packed in carry-ons, such as one backpack and small suitcase.

Each participant must thoroughly read their team materials distributed by trip coordinator and sign any required pages. This will be sent directly to team members prior to departure date.

Each participant agrees to pay close attention to facility rules, which will be explained upon arrival; including but not limited to the following:

No smoking in buildings
Exterior doors and windows are to remain locked if you are not in your room
Individuals who are not registered team members may not be invited to mission property or enter the premises.
Flip-flops or shoes must be worn at all times. No bare feet allowed.

I have read all of the above statements under “Terms and Conditions” and agree to them.*

I agree to the Terms and Conditions

Please click submit below to enter the e-sign page for this application. Once you sign and submit it, you will receive a copy of your signed application at the email address that you provided.

Name

This field is for validation purposes and should be left unchanged.

Select Language: