2027 Family VT - Registration

SportQuest Family Vision Trip Registration

Welcome to your SportQuest Vision Trip! Please complete this registration form by November 14th. If you have any questions, please email Miki Montoya at miki.montoya@sportquest.org. Thank you!
What Family Vision Trip are you Registering for:
Part 1: Adult #1

General Information, Skills & Interests, Medical Information
Adult #1 - General Information
Full Name:

First NameLast Name
Cell Phone:
Email:
example@example.com
Date of Birth:

MonthDayYear
Date
Gender:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a current passport?
What is your T-shirt size? (adult men's sizes)
Are you traveling with your spouse or another person?
Are you traveling with your children
Adult #1 - Skills & Interest
Have you ever been on any kind of vision/mission trip before? (If yes, please share when, where, and what did you do?)
Share why you chose this Vision Trip.

Please rate yourself in the following areas:

Please rate your athletic ability in the following sports:

Do you speak any other languages? (if so, share which language and at what level)
Chile, Panama - Spanish / Belgium - Dutch
Are you involved in a local church? (not required)
Please describe your involvement
Please describe where you're at in your spiritual journey.
Adult #1 - Medical Information

Our goal in asking this information is to make sure we can establish an environment for the success and health of all our participants. We will keep this information strictly confidential.
Do you have any allergies to food, medication, etc. If yes, please list each allergy.

For each of the medical conditions below, check YES if you have ever experienced this condition.

Rows	YES	NO
Diabetes
Seizures
Fainting Spells
Heart Problems
Respiratory Problems
Other (Please explain in next question)

If you checked "Yes" on any of the above questions, please explain here. Please indicate when you experienced this and if you are currently taking any medications and/or seeing a doctor concerning this condition.
Is there anything else in your background that would be important for us to know about?
Please explain in detail if you answered YES to the questions above.
Part 2: Adult #2

General Information, Skills & Interests, Medical Information
Full Name:

First NameLast Name
Cell Phone:
Email:
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:

MonthDayYear
Date
Gender:
Do you have a current passport?
What is your T-shirt size? (adult men's sizes)
Adult #2 - Skills & Interest
Have you ever been on any kind of vision/mission trip before? (If yes, please share when, where, and what did you do?)
Share why you chose this Vision Trip.

Do you speak any other languages? (if so, share which language and at what level)
Chile, Panama - Spanish / Belgium - Dutch
Are you involved in a local church? (not required)
Please describe your involvement
Please describe where you're at in your spiritual journey.
Adult #2 - Medical Information

Our goal in asking this information is to make sure we can establish an environment for the success and health of all our participants. We will keep this information strictly confidential.
Do you have any allergies to food, medication, etc. If yes, please list each allergy.

If you checked "Yes" on any of the above questions, please explain here. Please indicate when you experienced this and if you are currently taking any medications and/or seeing a doctor concerning this condition.
Is there anything else in your background that would be important for us to know about?
Please explain in detail if you answered YES to the questions above.
Part 3: Children's Information
Child 1 Full Name:

First NameLast Name
Child 1 Date of Birth

MonthDayYear
Date
Gender:
What is your child's T-shirt size?
Do they have a current passport?
Are you traveling with more than 1 child?
Child 2 Full Name:

First NameLast Name
Child 2 Date of Birth

MonthDayYear
Date
Gender:
What is your child's T-shirt size?
Do they have a current passport?
Are you traveling with more than 2 children?
Child 3 Full Name

First NameLast Name
Child 3 Date of Birth

MonthDayYear
Date
Gender:
What is your T-shirt size? (adult men's sizes)
Do they have a current passport?
Are you traveling with more than 3 children?
Child 4 Full Name

First NameLast Name
Child 4 Date of Birth

MonthDayYear
Date
Gender:
What is your T-shirt size? (adult men's sizes)
Do they have a current passport?
Part 3: Children's Medical History

Our goal in asking this information is to make sure we can establish an environment for the success and health of all our participants. We will keep this information strictly confidential.
Do your children have any allergies to food, medication, etc. If yes, please list each child and their allergy.

If you checked "Yes" on any of the above questions for Child # 1, please explain here.
Please indicate when they experienced this and if they are currently taking any medications and/or seeing a doctor concerning this condition.
If you checked "Yes" on any of the above questions for Child # 2, please explain here.
Please indicate when they experienced this and if they are currently taking any medications and/or seeing a doctor concerning this condition.
If you checked "Yes" on any of the above questions for Child # 3, please explain here.
Please indicate when they experienced this and if they are currently taking any medications and/or seeing a doctor concerning this condition.
If you checked "Yes" on any of the above questions for Child # 4, please explain here.
Please indicate when they experienced this and if they are currently taking any medications and/or seeing a doctor concerning this condition.

Adult Deposit$150.00

Quantity

Child Deposit $150.00

Quantity

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Rows	Child 1	Child 2	Child 3	Child 4
Diabetes
Seizures
Fainting Spells
Heart Problems
Respiratory Problems
Other (Please explain in next question)

SportQuest Family Vision Trip Registration