Ordinary Hero Mission Trip Application
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Palestine
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Portugal
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Rwanda
Saint Barthelemy
Saint Helena
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Senegal
Serbia
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Taiwan
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Thailand
Timor-Leste
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Other
Country
E-mail
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
*
-
Area Code
Phone Number
Mission Trip
Trip Destination
Dates of Trip
Departure Airport (closest airport to you)
*
Have you ever been on an overseas mission trip before?
Please Select
Yes
No
If yes, with what group/organization?
Please Select Trip You Would Like To Attend.
Please Select
December 28, 2017-Jan. 5, 2018; Team Leader: Kelly Putty
March 29-April 7, 2018 (Thompson Station Church); Team Leader: Lauren Putty
Apr. 22-30, 2018; Team Leader: Kelly Putty
Passport
Full Name on Passport
Nationality
Passport Issue Location
Passport Expiration
Passport Number
Vocation
Employer/School Name
Employer/School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Employer/School Phone Number
-
Area Code
Phone Number
Employer/School Email
Health
General Health
*
Please Select
Excellent
Good
Fair
Poor
Please List Any Allergies, Pre-existing Medical Conditions, or any Physical Limitations that could prevent you from certain activities (breathing, hearing, vision, mobility, etc)
Please List Any Special Dietary Needs
Personal History
Have you ever been convicted of a misdemeanor or felony?
*
Please Select
Yes
No
If yes, please explain. Include date of conviction.
Please list any special abilities you have (language, carpentry, musical, artistic, medical skills, etc)
Church Affiliation (if applicable)
Pastor
Church Phone Number
-
Area Code
Phone Number
Describe why you want to participate in this mission trip.
Code of Conduct
Ordinary Hero requires that our team members present themselves in a respectful, trustworthy manner in order to serve the people of the country we are visiting to the best of our ability. Please answer and agree to the following questions.
Are you willing to follow the authority of the Mission Trip Team Leader?
*
Please Select
Yes
No
Are you willing to work with a positive attitude as a member of a team?
*
Please Select
Yes
No
Will you refrain from criticizing the local culture's food, language, people, etc.?
*
Please Select
Yes
No
Will you refrain from use of alcohol and keep any form of nicotine habit to a minimum?
*
Please Select
Yes
No
Do you agree to stay with the group at all times and never venture off by yourself for any reason?
*
Please Select
Yes
No
Emergency Contact
Name
Relationship
Phone
Email
Other Info
Please give any other information you would like Ordinary Hero to be aware of as we review this application.
What size T shirt do you wear?
*
Please Select
Adult XS
S
M
L
XL
2XL
How did you hear about this trip?
Please note that if you have to cancel your spot on a trip, you will lose your deposit as well as any fees assessed by the airlines for canceling, as well as any money that has been donated on your behalf. If you choose to go on a trip within one year of the original trip you signed up for, your money can be used for that (minus any cancellation fees assessed by the airlines), other wise it will go to the overall budget of Ordinary Hero Foundation. Due to accounting restrictions we are unable to refund individuals (unless a trip has been canceled by OH). Please type yes if you have read and understand this policy.
*
I understand that the Life Center policy is 'No sponsor children on the premises". If you sponsor a child in Ethiopia, your team leader will make every reasonable effort to visit the ministry through which he/she is sponsored so you can meet and spend time with your sponsor child. If you sponsor a child in Talita, you may want to check with the team leader to see if it is on the itinerary for this trip. If you have any questions, please email beverly@ordinaryhero.org. Please type yes if you have read and understand this policy.
*
Media Release
I hereby consent to the participation in interviews and photography, both still and motion (videos) while traveling with The Ordinary Hero Foundation, hereby referred to as OH. I also grant to OH the irrevocable and unrestricted right to use my personal quotes/comments, as well as the right to publish photographs or movies taken of me, and the use of my name and/or likeness. I also grant to OH the right to edit, use, and reuse said products for non-profit purposes including, but not limited to, use in print, on the internet, and all other forms of media. I further understand that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these images. I also hereby release OH, its contractors, agents, employees, and third-parties involved in the creation or publication of marketing materials from all claims, demands, and liabilities whatsoever in connection with the above. By entering my initials in the box above, I consent to this release.
*
Please Note:
We reserve the right to obtain professional background check information. After submitting this application, we will need at least two character references submitted from either an employer, Pastor, friend, co-worker, etc. Please have character references emailed to beverly@OrdinaryHero.org. Have them include name, address, phone number, how they know you, how long they have known you, why they feel you would be a good team member of this mission trip, and any other info they feel necessary. No family members please.
Trip Down Payment
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Trip down payment
Application fee:
Upon sign up you will be asked to pay your $600 NON-REFUNDABLE deposit in order to be considered for this trip. Deposit will be applied toward total trip cost and secure your spot on the trip. If cancellation occurs after airline tickets are purchased, the $600 airline cancellation fee will also be NON-REFUNDABLE. Remember to make note of which trip you are signing up for in the Memo line when paying. Application is void without payment.
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