Service and Learning Experience Ministries (SALEM) Team Application

The trip coordinator should complete one application form on behalf of the
entire group. Afterwards, follow-up information will be requested from all
of the participants.
Name:
_____________________________________________________________________________________
First

Middle

Last

Organization Name:
_____________________________________________________________________________________
Date of Birth ________________________________ Age _____________ Gender
__________________
Organization (i.e., church) Address:
_____________________________________________________________________________________
_____________________________________________________________________________________
Home Phone ________________ Cell #________________
Email Address: _________________________
Estimated number of participants: ___________
__________________

Anticipated trip dates:

Are there any special needs that your group may have, that we may anticipate
accommodating? I.e., participants with physical disabilities, etc.

Does your group have an interest in a specific type of work, or work within a specific
setting? We will do our best accommodate all requests; however, our projects are
ultimately conducted based on needs of the community.

Please share any special skills or abilities your organization would like to share wth
the host community here.

Service and Learning Experience Ministries (SALEM) Participant

Application
Each participant must complete the following application form. These must be
received via email or fax prior to in-country arrival.
Name:
_____________________________________________________________________________________
First

Middle

Last

Date of Birth ________________________________ Age _____________ Gender

________________
Address
_____________________________________________________________________________________
_____________________________________________________________________________________
Home Phone ________________ Cell #________________
E-mail Address: _________________________
Shirt size: (please circle)
3X
4X

Small

Medium

Large

XL

2X

Passport Number: ________________________ Country of Citizenship:

__________________________
Place and date of issue:_________________________ Expiration Date:
___________________________
Please list any known food allergies or other dietary regulations (vegetarian, vegan,
diabetic, etc.). If none, please write NA.
_____________________________________________________________________________________
_____________________________________________________________________________________
Please list any known environmental allergies, or any other relevant medical
conditions (i.e., high-blood pressure) that would impede your ability to do physical
labor. If none, please write NA.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

EMERGENCY CONTACT

Name: ______________________________ Relationship: ________________________________

Phone Number: ______________________________________
Email Address:______________________ __________________