ARO Mission Trip Registration

Trip Dates: July 6-12, 2024

Personal Information

First Name *

Last Name *

Home Address *

Home Address Line 2

Home City *

Home State *

Home Zip Code *

What is your preferred method of communication? *

Text

Text or Email

Email Address *

Primary Phone Number *

Will you be 18+ at the time of the trip? *

Yes

Will you be traveling w/ a parent? *

Yes

Medical Information

Any known allergies? *

Yes

Unknown

Allergies (List) *

Is your tetanus shot up to date? *

Yes

I don't know

PLEASE NOTE: Having a current tetanus shot on record is a requirement for this trip. Students not traveling with a parent will need to provide a copy of this record.

PLEASE NOTE: Having a current tetanus shot on record is a requirement for this trip. Please have one scheduled at your earliest convenience. Students not traveling with a parent will need to provide a copy of this record.

For Students Not Traveling w/ a Parent:

Any medical conditions we should be aware of? *

Yes

Medical Conditions (List) *

Are you on any medication? *

Yes

Medications (List) *

What medication (if any) do we have permission to administer if needed? *

None

Tylenol

Ibuprofen

Benadryl

Other

Other Medications (List) *

Parent/Guardian Info

Primary Parent/Guardian Name *

Primary Parent/Guardian Phone Number *

Primary Parent/Guardian Email Address *

2nd Parent/Guardian Name

2nd Parent/Guardian Phone Number

2nd Parent/Guardian Email address

Emergency Contact Info

Emergency Contact Name *

Emergency Contact Phone Number *

2nd Emergency Contact

2nd Emergency Phone

Insurance Info

Insurance Company *

Policy Number *

Name of Policy Holder *

Phone Number of Insurance *

Skills & Talents

Regardless of age and/or physical limitations you may have, there is work that can be done! That said, we can more effectively plan for the work we'll do on this trip if we know any skills or talents you might have.

What do you have experience doing? Is there anything you love to do?

Painting

Plumbing

Electrical

Carpentry

Heating/Cooling

Drywall

Masonry

Landscaping

Other

If other, please list: *