CRWRC:

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Discovery Tour Application

Question - Required - Your Tour

Your Information

Please enter your full legal name as it appears in your passport:

Name:

First Required	Middle Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Country: Required

Phone Number: Required

Date of Birth: Required

Date of Birth:

Month

Day

Year

Yes, I would like to receive e-mail from CRCNA

Question - Not Required - Other phone number:

Question - Required - Citizenship:

Question - Not Required - Passport # (US Citizens):

Question - Not Required - Passport Expiration Date:

Month

Day

Year

Question - Not Required - Occupation

Emergency Contact Information

Question - Required - First and Last Name:

Question - Not Required - Relationship to Participant:

Question - Required - Full Address (street, city, state/prov, zip/postal code)

(Maximum response 255 chars, approx. 5 rows of text)

Telephone Numbers:

Question - Required - Home:

Question - Not Required - Work:

Question - Not Required - Other:

Question - Required - Email Address:

Medical Information

Question - Not Required - Do have any health problems that we should be aware of that may limit full participation? (diabetes, heart problems, allergies, etc):

(Maximum response 255 chars, approx. 5 rows of text)

Question - Required - Primary Physician:

Question - Not Required - Primary Physician Phone Number:

Question - Not Required - Medical Insurance Contact Information:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Medical Insurance Policy #:

Other Information

Question - Not Required - How did you hear about our Discovery Tour opportunity?

Question - Not Required - Have you volunteered with us previously? Yes
No

Question - Not Required - If yes, please provide details:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Do you speak any foreign languages? If yes, please list and indicate your level of proficiency:

(Maximum response 255 chars, approx. 5 rows of text)

Other

Question - Not Required - Church Affiliation:

Question - Not Required - Local church involvement:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Describe your faith journey:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Why do you want to participate in this opportunity?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - What do you hope to learn from this opportunity?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How do you plan to share your experience with others?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Have you had any cross cultural experiences?

(Maximum response 255 chars, approx. 5 rows of text)

Beginning Preparations

Read the Participant Tour Agreement
Call your doctor or local health department about immunizations that will be needed for your trip.
Check your passport to make sure that it will be current for six months after your tour is scheduled to leave.
Balance of the tour cost will be due 45 days prior to the date your tour is scheduled to leave.

Submit your US $250 deposit to:

United States:
CRWRC
attn: Mary Dykstra
2850 Kalamazoo Ave SE
Grand Rapids, MI 49560

ph: 1-800-552-7972
email: servicelearning@crcna.org

Canada:
CRWRC
attn: Iona Buisman
3475 Mainway, PO Box 5070
STN LCD 1
Burlington, ON L7R 3Y8

ph: 1-800-730-3490
email: volunteer@crcna.org