Trip Application

Select a Trip/Date(Required)

First & Middle Name (as they appear on your passport)(Required)

Last Name (as it appears on your passport)(Required)

Birthdate(Required)

Please list your preferred airport(s) in order of preference. (ie: the airport(s) you want to fly out of)(Required)

Do you have a current US Passport? (If not - please apply for one now. You cannot travel to Nicaragua without one)(Required)

Passport Number (Put 0's if you do not currently have your passport)(Required)

Passport Expiration Date(Required)

Passport Nationality(Required)

Street Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Phone(Required)

Email(Required)

Gender(Required)

How did you hear about this trip?(Required)

Have you had previous experience on the mission field or traveled in a foreign country?(Required)

If yes, please list countries and experience

What are your expectations for this trip?(Required)

Please describe your health, including physical or dietary limitations(Required)

Are you on regular medications or currently under a doctor's care?(Required)

If yes, briefly explain

Please list any allergies (food, medicine, environment, insect, etc.)(Required)

Date of Last Tetanus (skip if you don't know)

Blood Type (skip if you don't know)

Do you speak fluent Spanish?

This trip may require strenuous physical activity for extended periods of time. Do you have any conditions (medical or otherwise) that may prevent you from fully participating?(Required)

If yes, please briefly explain

Please list any medical, First Aid, or CPR training

Please list any special talent or gifting that may be utilized on the trip(Required)

Is there anything else we should know about you?

Emergency Contact #1(Required)

Emergency Contact #1 Email(Required)

Emergency Contact #1 Phone(Required)

Emergency Contact #2(Required)

Emergency Contact #2 Email(Required)

Emergency Contact #2 Phone(Required)

Today's Date

By checking this box I acknowledge and warrant that the information that I have provided on this form is true and correct to the best of my knowledge. I further agree to immediately notify SuNica of any change in the information presented. I understand that this form is valid and legally binding.(Required)

I agree

I understand that completing this form requires a $250 trip deposit (which can be paid by clicking the button below and selecting "Trips Payment" on the dropdown menu)(Required)

I agree