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Instructions
Application Form
Health Questionaire
Release and Consent Form
Release and Consent Form
Documentation Upload

Instructions

Welcome!

Online Application for SFX Mission Trip

Please review the information below prior to beginning the application process.This is an online application.

Please answer the next questions, upload all necessary documentrs and pay via Paypal / Check.

It is HIGHLY recommended that you have these items ready prior to beginning the application process. This will help alleviate frustration in successfully completing the application in a timely fashion.

Click on each item below for further details and instructions.

1. A recent photograph of yourself

Please make sure the applicant is clearly visible in the photo.
Acceptable upload file formats are: JPG, JPEG, PNG and GIF
Maximum file upload size is: 5mb

2. Application Essay

On a separate sheet of paper (or Word document), please write an essay answering ALL the following questions:
(Essay should be 500‐750 words in total.)

Tell us a little bit about yourself. (e.g. family, interests, activities, etc.)
If you have been a part of a trip like this before, what did you gain from that experience?
What do you hope to gain from this experience?
What do you hope to give or contribute to the mission?
After reading the 2017 Fundraising Packet, what specific plans do you have for Fundraising?

Acceptable upload file formats for the Application Essay are DOC, DOCX, PDF, TXT, JPG, JPEG, PNG and GIF
Maximum upload size is: 5mb

3. Photocopy of BOTH sides of your Health Insurance Card

Please note: if you do not have Health Insurance yet you can complete the application process and send the photocopy once you have acquired it.

Acceptable upload file formats for the photocopy of your Health Insurance Card are JPG, JPEG, PNG and GIF
Maximum upload size is: 5mb

4. Photocopy of the Photo Page of your Passport

Please note: if you do not have your Passport yet you can complete the application process and send the photocopy once you have acquired it.

Acceptable upload file formats for the photocopy of your Passport are JPG, JPEG, PNG and GIF
Maximum upload size is: 5mb

5. Letter of Recommendation

All applicants are required to provide a Letter of Recommendation. Two options are available for providing a Letter of Recommendation:

One Letter of Recommendation from a priest of the Priestly Fraternity of St. Peter… OR
One Letter of Recommendation from your parish priest AND
One Letter of Recommendation from an adult who knows you well but is not a family member.

Please click here below to download a PDF of instructions for the Letter of Recommendation

Acceptable upload file formats for the Letter(s) of Recommendation are DOC, DOCX, PDF, TXT, JPG, JPEG, PNG and GIF
Maximum upload size is: 5mb

Once you have acquired the items above please fill in the information below to begin.

Please note: The information collected below should be of the person filling out this form (not necessarily the applicant’s information).

First Name*

Last Name*

Full Name Title*

Email*

Phone*

City

State

Date Time of application

Checklist of Documents*

Please check each box below for the documents you have already acquired.

A recent photograph of yourself

Application Essay

Photocopy of Health Insurance Card

Photocopy of Passport

Letter of Recommendation

I dont have passport yet 🙁

No passport yet

Health Questionaire

Name of Applicant*

We are aware of and respect the private nature of the following questions. Accurate and full answers are important to ensure our ability to provide for the well-being of all attending.

Do you have, or have ever had, or been told you have:*

	Yes	No
	Yes	No
Allergies
Any childhood diseases
Frequent colds or sore throats
Frequent earaches
Heart murmur or heart abnormality
Reaction to insect sting or medications
Shortness of breath
Frequent stomach or digestive problems
Asthma
Convulsions
Depression
Suicidal Thoughts
Frequent or severe headaches
High blood pressure
“Passed out” or “knocked out”
Skin problems

Please explain all 'yes' answers chosen above*

Please list/explain any food or diet restrictions you may have:

Please list any medications you are currently taking:

Date of most recent Tetanus Booster:

Do you wear Glasses/Contact lenses?

Hearing Aid?

Name of Family Physician:

Physician's Phone Number:

Do you have Health Insurance?*

Yes

Under whose name?*

Policy #:*

Name and Address of Health Insurance Provider:*

Does your health insurance policy cover you internationally?

Do you have Traveler’s Insurance?*

Traveler's Insurance is HIGHLY recommended

Yes

Traveler’s Insurance Information:*

I am aware that the US Centers for Disease Control (CDC) recommends certain vaccination and malaria pills for persons traveling to Peru/Mexico as a precautionary measure. I attest that I have read the recommendations listed on the CDC’s website: http://www.cdc.gov/travel/destinations/

Please check one*

I (or my child) have/has received the recommended vaccinations.

I am aware of the recommendations but have opted not to get these vaccinations.

I/my child carries*

(if yes, must carry with you/him/her)

	Yes	No
	Yes	No
Inhaler
Epi-Pen

I testify that the information contained above is true and accurate to the best of my knowledge:

Sign your name with your computer mouse (Parent/Guardian if under 18)

Date*

Release and Consent Form

For missionaries over the age of 18:

Full Name*

do hereby consent to participate in the St. Francis Xavier Mission Trip to MEXICO (hereinafter referred to as “the Mission Location”)…

do hereby consent to participate in the St. Francis Xavier Mission Trip to PERU (hereinafter referred to as “the Mission Location”)…

do hereby consent to participate in the St. Francis Xavier Mission Trip to DOMINICAN REPUBLIC (hereinafter referred to as “the Mission Location”)…

….I acknowledge that participation in the St. Francis Xavier Mission Trip will involve traveling to the Mission Location and working among the local population. It will include activities which, by their nature, involve an element of risk. While in the Mission Location, participants will be staying in accommodations provided by the local parish and eating meals prepared by members of the parish. The group may also travel to and spend short amounts of time, including possible overnight stays, in other cities near to the Mission Location.

I do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify, and agree to hold harmless any and all adults who chaperone this event, all other participants, St. Francis Xavier Mission Trip, Our Lady of Guadalupe Seminary, The Priestly Fraternity of Saint Peter and the members and employees thereof, and any of the above named parties’ representatives, successors, supervisors, sponsors, and/or organizers, for any injuries in connection with the above mentioned trip provided that the said injuries are not the result of negligence.

Initials*

I also give permission to seek any emergency care should I be involved in any accident or be injured in any way during such events named above. I understand that in any such instance, all attempts will be made to contact the Emergency Contacts listed on page 1 of this application. In the event that the Emergency Contacts cannot be reached, I hereby give permission to the attending physician to hospitalize if necessary, and secure the necessary treatment for me. I understand that any medical expenses incurred in the course of such treatment are my responsibility in the event I do not have sufficient medical insurance/coverage.

Initials*

I also agree that I am legally responsible for all/any personal action taken by me during this trip, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of my actions or behavior.

Initials*

I further agree by signing this form that I will follow all the rules of this trip and the directions of the priests, seminarians, and chaperones. I agree that if I refuse to abide by the rules, there will be consequences, including the possibility of being removed from the trip and sent home at my own expense.

Initials*

Sign your name with your computer mouse

(please note: if the signature pad is too small in height then please refresh this page. You will not lose any data.)

Date*

Printed Name:*

Release and Consent Form

For parents of missionaries under the age 18:

Full Name*

do hereby give my/our consent for my/our
son/daughter/guardianship (hereinafter referred to as “Child”) to participate in the St. Francis Xavier Mission Trip to MEXICO (hereinafter referred to as “the Mission Location”)…

do hereby give my/our consent for my/our
son/daughter/guardianship (hereinafter referred to as “Child”) to participate in the St. Francis Xavier Mission Trip to PERU (hereinafter referred to as “the Mission Location”)…

….I/We acknowledge that participation in the St. Francis Xavier Mission Trip will involve traveling to the Mission Location and working among the local population. It will include activities which, by their nature, involve an element of risk. While in the Mission Location, participants will be staying in accommodations provided by the local parish and eating meals prepared by members of the parish. The group may also travel to and spend short amounts of time, including possible overnight stays, in other cities near to the Mission Location.

I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify, and agree to hold harmless any and all adults who chaperone this event, all other participants, SFX Mission, Our Lady of Guadalupe Seminary, The Priestly Fraternity of Saint Peter and the members and employees thereof, and any of the above named parties’ representatives, successors, supervisors, sponsors, and/or organizers, for any injuries in connection with the above mentioned trip provided that the said injuries are not the result of negligence.

Initials*

I/We also give permission to seek any emergency care should my Child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent(s)/guardian(s) or Emergency Contacts listed on page 1 of this application. In the event that the Emergency Contacts/parent(s)/guardian(s) cannot be reached, I/we hereby give permission to the attending physician to hospitalize if necessary, and secure the necessary treatment for my Child. I/We understand that any medical expenses incurred in the course of such treatment are my/our responsibility in the event I/we do not have sufficient medical insurance/coverage.

Initials*

I also agree that I am legally responsible for all/any personal action taken by my Child during this trip, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of my Child’s actions or behavior.

Initials*

I/We further agree by signing this form that my Child will follow all the rules of this trip and the directions of the priests, seminarians, and chaperones. I agree that if my Child refuse to abide by the rules, there will be consequences, including the possibility of being removed from the trip and sent home at my/our own expense.

Initials*

Parent/Guardian: Sign your name with your computer mouse or tablet

Date*

Parent/Guardian's Printed Name:*

For missionaries under the age of 18:
In signing below, I agree to abide by any/all policies and rules established for this trip. Should I not be able to maintain the guidelines and expectations for this trip as given by the priests, seminarians, and chaperones, I understand that there will be consequences for my actions, including the possibility of being removed from the trip and sent home at my parent(s)/guardian(s) expense.

Participant Signature: Sign your name with your computer mouse

Date*

Participant's Printed Name:*

Documentation Upload

Please upload your documents below.

Upload a recent Photograph of the Applicant

Drag 'n Drop files here

Max file size: 5.00 MB. | Allowed file types: gif,jpeg,png,jpg | Max number of file: 1 | Min number of file: 1

Upload your Application Essay

Drag 'n Drop files here

Max file size: 5.00 MB. | Allowed file types: doc,docx,pdf,txt,gif,jpeg,png,jpg | Max number of files: 2 | Min number of file: 1

Upload a Photocopy of BOTH sides of your Health Insurance Card

Drag 'n Drop files here

Max file size: 5.00 MB. | Allowed file types: gif,jpeg,png,jpg | Max number of files: 2 | Min number of file: 1

We noticed that you did not check the box for “Photocopy of Health Insurance Card” in the document checklist at the beginning of this application process (on the Instructions page). The upload box will show up here once that box has been checked. If you have not yet acquired Health Insurance you will have the option to upload the Photocopy after the application is submitted.

Upload a Photocopy of the Photo Page of your Passport

Drag 'n Drop files here

Max file size: 5.00 MB. | Allowed file types: gif,jpeg,png,jpg | Max number of file: 1 | Min number of file: 1

We noticed that you did not check the box for “Photocopy of Passport” in the document checklist at the beginning of this application process (on the Instructions page). The upload box will show up here once that box has been checked. If you have not yet acquired your Passport you will have the option to upload the Photocopy after the application is submitted.

Upload your Letter(s) of Recommendation

Drag 'n Drop files here

Max file size: 5.00 MB. | Allowed file types: doc,docx,pdf,txt,gif,jpeg,png,jpg | Max number of files: 10 | Min number of file: 1

Please, add any comments and specifications here!*

	Yes	No
	Yes	No
heart disease
diabetes
convulsions
emotional disorders
any other health conditions

Apply

Form successfully restored

Instructions

Welcome!

Online Application for SFX Mission Trip

1. A recent photograph of yourself

2. Application Essay

3. Photocopy of BOTH sides of your Health Insurance Card

4. Photocopy of the Photo Page of your Passport

5. Letter of Recommendation

Application Form

Please indicate which trip you are applying for:

Please complete the following information:

Emergency Contact information

Additional Information

Please read and acknowledge ALL the following statements (type your initials in the box below each statement):

Sign your name with your computer mouse (Parent/Guardian if under 18)

Health Questionaire

Sign your name with your computer mouse (Parent/Guardian if under 18)

Release and Consent Form

For missionaries over the age of 18:

Sign your name with your computer mouse

Release and Consent Form

For parents of missionaries under the age 18:

Parent/Guardian: Sign your name with your computer mouse or tablet

Participant Signature: Sign your name with your computer mouse

Documentation Upload

Upload a recent Photograph of the Applicant

Upload your Application Essay

Upload a Photocopy of BOTH sides of your Health Insurance Card

Upload a Photocopy of the Photo Page of your Passport

Upload your Letter(s) of Recommendation

Your form has been submitted

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Error

	Yes	No
	Yes	No
for physical illness
for psychological illness
undergone surgery

	Yes	No
	Yes	No
present illness
physical disabilities
mental disabilities

	Yes	No
	Yes	No
Aspirin
Tylenol
Benadryl