Mount Elgon for Education Friends of Ravens Ark Trip Application

Mount Elgon for Education Friends of Ravens Ark Trip Application

Online trip application form. Please complete all questions and the signature/consent section using the attached PDF as reference.
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Address Line 2
City / State / ZIP
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Occupation/Employer
Church/Organization
T-shirt Size
Passport and Travel History
Do you currently have a valid passport?
Passport expiration date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you traveled internationally before?
If yes, list the countries or regions you have visited
Have you previously traveled to Africa?
If yes, where in Africa have you traveled?
Emergency Contact
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Relationship
Emergency Contact Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Secondary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Motivation and Experience
Why are you interested in participating in the Mount Elgon for Education trip?
What do you hope to learn, experience, or contribute through this trip?
What skills, experience, or interests could be helpful to the team?
Have you participated in a mission, service, humanitarian, or international development trip before?
If yes, briefly describe your prior trip experience(s).
How would you describe yourself as a member of a team?
How do you respond when plans unexpectedly change or circumstances are outside your control?
Are you comfortable taking direction from trip leaders and local Ugandan hosts?
Are you willing to respect local customs, cultural expectations, dress guidelines, and team policies while participating in the trip?
General Health and Medical History
How would you describe your general health?
If other, please describe your general health.
Do you have any current medical conditions that could affect international travel, hiking, physical activity, heat, altitude, diet, or participation in this trip?
If yes, please explain your current medical conditions.
Do you have any heart or cardiovascular condition?
If yes, please explain your heart or cardiovascular condition.
Do you have any blood pressure condition?
If yes, please explain your blood pressure condition.
Do you have asthma or another respiratory condition?
If yes, please explain your asthma or respiratory condition.
Do you have diabetes or another blood sugar condition?
If yes, please explain your diabetes or blood sugar condition.
Do you have seizures or another neurological condition?
If yes, please explain your seizures or neurological condition.
Do you have any serious allergies?
If yes, please explain your serious allergies.
Do you have any severe food allergies?
If yes, please explain your severe food allergies.
Do you have any mobility limitations?
If yes, please explain your mobility limitations.
Do you have any knee, ankle, hip, or back concerns?
If yes, please explain your knee, ankle, hip, or back concerns.
Have you had difficulty at high altitude before?
If yes, please explain your altitude difficulty.
Have you had any recent surgery or hospitalization?
If yes, please explain your recent surgery or hospitalization.
Do you have any other condition we should know about?
If yes, please explain your other condition.
Medications, Allergies, and Physical Ability
Do you have any allergies to medications, foods, insects, or other substances?
If yes, please describe the allergy and your typical reaction.
Do you carry an EpiPen or other emergency medication?
Are you currently taking any prescription medications that trip leadership should be aware of in an emergency?
If yes, please list the medication and any relevant information.
Are you currently able to walk or hike for several hours over uneven terrain?
Do you have any physical limitations that may affect your ability to participate in planned activities?
If yes, please explain any physical limitations.
Is there anything else regarding your physical or emotional well-being that would be important for trip leadership to know?
Dietary Information
Do you have any dietary restrictions?
If yes, please explain
Food allergies
Dietary preference

Other
If other, please specify
Health, Travel, and Trip Commitment
Are you willing to consult your healthcare provider or a travel medicine clinic about precautions for travel to Uganda?
Do you understand that international travel may involve conditions different from those at home?
Are you willing to participate in fundraising and awareness-building activities connected with this trip?
Are you comfortable sharing the purpose of this trip with friends, family, your church, workplace, and/or social network?
Please describe any fundraising experience you have, if applicable.
Reference and Consent
Reference Name

First NameMiddle NameLast Name
Reference Relationship
Reference Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference Email
example@example.com
Applicant Name

First NameMiddle NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Mount Elgon for Education Friends of Ravens Ark Trip Application

Applicant Information

Passport and Travel History

Emergency Contact

Motivation and Experience

General Health and Medical History

Medications, Allergies, and Physical Ability

Dietary Information

Health, Travel, and Trip Commitment

Reference and Consent