trip app

Click here for a downloadable form if you don’t want to use our online version. Once complete, please scan and email your form to admin@fcmhonduras.org. Feel free to contact us if you have any questions.

Team Name

Name As Listed on Passport *

Passport Number

Passport Expiration Date

Date of Birth *

Payment Preference

Gender *

Shirt Size *

Email *

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Arrival Flight

Arrival Date

Arrival Time

Departure Flight

Departure Date

Departure Time

Please list any medical conditions that you have which are treated by a doctor.

Please list any allergies that you have.

Please list any medications that you take as prescribed by a doctor.

Emergency Contact Name *

First

Last

Emergency Contact Phone

Emergency Contact Email *

Confirm Email

Additional Information

Have you ever been arrested for, charged with, or convicted of any type of crime having to do with child molestation, sexual assault, rape, indecent exposure, or any sexual related offense? *

Are you a Christian? *

How long have you been a Christian? *

What church are you a member of? *

Please write a brief testimony of your salvation. *

Read the team member regulations, behavioral guidelines, and release here.

Please confirm that you have read and agree. *