College Expeditions Enrollment Form
Please give thought to each answer so that we can get to know you better before your trip. The La Vida staff use this form to place you in a group. We will follow up with you on any food or medical needs you might have.
First Name
*
Last Name
*
Nickname
College ID number (Please ensure correct entry so we can match your record.)
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Gordon Email
example@example.com
Personal Email (if you have not been assigned a Gordon email yet)
*
example@example.com
Household/parent or guardian email
example@example.com
Sex
*
Male
Female
Age
*
Birth date (mm/dd/yyyy)
*
Year in college at time of registration
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Incoming
Freshman
Sophomore
Junior
Senior
Home Phone
*
-
Area Code
Phone Number
Cell Phone
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
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
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
Course preference and availability for PED016 2023. Please note the August trip may be split into two departure dates to accommodate the number of students. You will be notified of your departure date after you apply. International Students are strongly recommended to sign up for August expedition to ease travel logistics.
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June Trip 6/20-7/1 (incoming and current students)
July Trip 7/4-7/15 (incoming students only)
Late July Trip 7/18-29 (incoming students only)
August Trip 8/6-17 (incoming students only)
Specific trip type request (The primary mode of travel for "Mountain" is hiking on trails. The main mode of travel for "Canoe" is on the water. )
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Mountain
Canoe
Any
Reason for trip type request:
Height
*
Weight
*
Major
*
Extracurricular activities:
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How did you hear about and decide to register for this expedition? What is the main reason you want to go on the trip?
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Most students have never camped before La Vida, but if you have any previous camping, hiking, or canoeing experience, please let us know:
*
What three words best describe your temperament?
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What three goals would you hope to accomplish during your La Vida experience?
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La Vida highly values community and the input of each individual in the group. What gifts, talents, values, etc., would you bring to your La Vida small group?
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Are you taking any prescribed medications? Please list the medication and reason for taking it. Do you anticipate any change in medication or dosage for your expeditions?
*
Do you have any allergies or dietary needs? Please check all that apply.
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No Allergies
Celiac (you have been diagnosed as Celiac by a doctor and cannot have any cross-contamination with wheat products)
Gluten-Free (you have a gluten intolerance)
Dairy-Free (you have an allergy to milk products)
Lactose-intolerant (you have an intolerance to lactose)
Peanut Allergy
Tree Nut Allergy
Vegetarian
Vegan
Bee Allergy
Other
Please explain the allergy and its severity:
*
Do you carry an EpiPen for your allergy? (If yes, please note you must bring your own EpiPen in addition to the ones we carry in the first-aid kit.)
*
Yes
No
Due to the strenuous nature of the activities and remote environment, are there any physical, emotional, or mental health concerns we need to be aware of?
*
Are there any special logistical needs, requirements, or prayer request for this experience? Your trip leaders pray for you by name before the expedition.
*
On a scale of 1 to 10, rate yourself in health
*
Please Select
1
2
3
4
5
6
7
8
9
10
1- Health related issues are extremely challenging 10- No on-going health issues
On a scale of 1 to 10, rate yourself in physical strength
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Please Select
1
2
3
4
5
6
7
8
9
10
1- A lot of difficulty lifting and carrying 30 lbs suitcase 10- Can easily lift and carry a 50 lbs suitcase
On a scale of 1 to 10, rate yourself in endurance
*
Please Select
1
2
3
4
5
6
7
8
9
10
1- Difficulty talking after walking up one flight of stairs 10- Able to jog 8+ miles
On a scale of 1 to 10, rate yourself in desire for spiritual growth
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Please Select
1
2
3
4
5
6
7
8
9
10
1- Not interested in spiritual discussion or reflection 10- Extremely interested in spiritual growth
Would you like to clarify any of the ratings above?
Are you an international student?
Yes
No
I have read the cancellation policy and agree to abide by that policy. I understand that I may be charged $50-$300 for canceling before the trip starts
*
Yes
Submit
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