Bosco Ministries Mission Trips Application

Application for mission trips managed by Bosco Ministries. Please ensure you select the proper program.

Select Your Trip

School Currently Attending (Official Name)

Applicant First Name

Applicant Last Name

Birthdate

Are you a U.S. Citizen? Only U.S. Citizens can attend this trip.

Passport Expiration Date - YYYY-MM-DD

Weight

Height

Address Line 1

Address Line 2

City

State

Zipcode/Postal Code

Phone

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone. Preferably mobile.

Emergency Contact Relationship to Applicant

Pertinent Non-Medical Information

Do any members of the applicant’s family have a history of heart disease, diabetes, seizures, mental or emotional illnesses?

Does the applicant have any present physical illness or disability?

Does the applicant have a history of or currently have any emotional or mental illnesses including but not limited to: depression, anxiety, autism, Down Syndrome?

Does the applicant have a history of behavioral problems, drug or alcohol use?

Will the applicant be taking any medications during the time of the program?

Allergies?

Please explain all 'Yes' answers to the above list. If the applicant requires any particular consideration, care, medication, (e.g. epipen, protective head gear for sports, etc.) please explain here.

Please note any other pertinent medical history details:

A special diet? (e.g. Allergies)

Any other special requirements we should be aware of?

If any special requirements, please list them here.

I want to use Bosco Ministries provided fundraising instead of paying full price up front.

I am aware that I am soley responsible for any travel insurance, including health insurance.

I am under the age of 18 filling out this application with the permission and supervision of a parent or legal guardian.

Parent Email for Minor Applicant

By completing this application, I acknowledge and agree to all of the terms, release, and consent available for review on the Bosco Ministries website, and required by Bosco Ministries.