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International Mission Trip Application

Thank you for taking the first step in applying to serve internationally with us! Samaritan’s Feet uses international shoe distributions as a tool to build relationships and share the gospel with people around the globe. Working with long-term, cross-cultural missionaries and national ministry leaders, Samaritan’s Feet is also involved in community development, medical clinics, and education.

You can also access a printable version of the application here to mail in.

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Trip Country
Trip Dates

Personal Information

First Name
Middle Name
Last Name
Preferred Name
Gender
Social Security Number
Birthdate
Age
Mailing Address
City, State, Zip
Cell Phone Number
Additional Phone Number
Occupation
T-Shirt Size
Have you been convicted of, or plead guilty to any criminal offense (other than juvenile offense now expunged from your record), or released from prison in the past ten years? Have you ever been convicted of or plead guilty to a felony?
Describe in full.
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Passport & Travel Information

Name as it appears on Passport
Passport Number
Passport Expiration Date
Place of Issue (Country, State, & City)
Passport Date of Issue

Travel: Please let us know what airport you would like to depart from.

Departure City & Airport #1
Departure City & Airport #2
Samaritan's Feet books all flights. However, if you have any flight deviation (ex: different return date) or you have an exception to book your own flight (ex: using your frequent flyer points), please indicate that here and our missions team will contact you:

Minor Information

Are you under the age of 18?
For most trips, participants must be 16 to travel alone. If younger than 16, you must be accompanied by an adult or guardian. All persons under the age of 18 who are not traveling with both parents must submit additional documents (birth certificate and a notarized letter) and details will be provided.
Parent/Legal Guardian Name
Parent/Legal Guardian Address
Parent/Legal Guardian Cell Phone Number
Parent/Legal Guardian Additional Phone Number
Checking the box below and giving the date serves as your signature. By doing so you are agreeing to the following: I, the parent or legal guardian, give permission for my dependent to participate in Samaritan's Feet International Shoes of Hope volunteer activities.
Date

Experience

Please check the areas where you have previous experience:
Please list any other skills and talents that may be helpful on the mission field. Also use this space to elaborate on any of the above checked items.
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Have you served on any other mission humanitarian projects before?
Please describe the project type, dates, and your responsibilities.
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Insurance

Supplemental traveler's insurance will be provided through an outside travel insurance agency.

Your Beneficiary
Checking the box below and giving the date serves as your signature. By doing so you are agreeing to the following: If I am accepted for a Samaritan's Feet project, I wish to make clear my understanding that Samaritan's Feet does not assume any responsibility for loss of property, damage to the same, personal harm or illness that may come; I, for myself, my heirs, executor, administrators, distributes and assigns, in consideration of my admission to volunteer mission projects and other good and valuable considerations, do hereby absolve said Samaritan's Feet and hold them harmless from any claim or demand which I or they might conceivably assert upon the basis of foregoing.
Date

Medical Information

Do you have any existing physical condition which may require medical attention during your project?
If yes, please explain below.
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Do you require a wheelchair at the airport?
Can you walk unassisted for at least 2 miles?
Medications Required
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Allergies
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Emergency Contact Information

Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Cell Phone Number
Emergency Contact Additional Phone Number

References

Please select three individuals as references. Good examples of references are a church staff member, campus minister, youth minister, co-worker, friend, someone who has observed you in a situation related to this type of trip, or someone who has observed your spiritual life/growth. Please do not list relatives or household members.

Reference #1

Name
Title
Cell Phone Number
Additional Phone Number
How long have you known this reference?

Reference #2

Name
Title
Cell Phone Number
Additional Phone Number
How long have you known this reference?

Reference #3

Name
Title
Cell Phone Number
Additional Phone Number
How long have you known this reference?

Team Manual Agreement

Checking the box below and giving the date serves as your signature. By doing so you are agreeing to the following: I, hereby agree to read and abide by the Code of Conduct, Rules and Guidelines, Dress Code, etc. stated in the Samaritan's Feet Ambassador Mission Training Guide.
Date

Final Agreement & Signature

Our Mission: Provide hope, love, and relief to suffering and impoverished children around the world, encouraging people to lead, serve and experience the life-changing power of God through whatever means possible.


Conditions of Volunteer Participation and Release from Liability: Samaritan’s Feet’s desire is to build a community of empowered volunteers dedicated to developing into servant leaders both physically and spiritually. As a volunteer, I will cooperate in the fulfillment of Samaritan’s Feet mission, while encouraging others to join in this worthwhile campaign of bringing relief to children in need around the world. Minors under the age of 16 who plan to travel without a parent or guardian must seek approval from the Samaritan’s Feet office. For more information, please visit www.samaritansfeet.org, or call 704.341.1630 or toll free at 866.833.SHOE. Also e-mail info@samaritansfeet.org.


Background Certification: I certify that all of the information provided on this application is true and complete. I authorize the Samaritan’s Feet staff to investigate and verify any and all of the information I have submitted. Because Samaritan’s Feet strives to provide a safe environment for children and youth, I understand that the Samaritan’s Feet may order a criminal history check, and I authorize this investigation. Samaritan’s Feet reserves the right to deny any application due to results of background check.


Volunteer TermsI agree to abide by Samaritan’s Feet policies, procedures and Code of Conduct. I understand Samaritan’s Feet does not provide any health benefits (i.e. medical, dental, workers compensation, etc.) or any accident insurance for me as a volunteer; I understand it is my responsibility to provide this coverage. I understand that Samaritan’s Feet does not provide volunteer compensation or trade volunteer services for paid mission trips.


Property Loss: I understand Samaritan’s Feet is not responsible for my personal property lost, damaged or stolen while participating in Samaritan’s Feet volunteer activities.


Baggage: All checked baggage will be used for bringing Samaritan’s Feet shoes and supplies into the country. All personal items must be packed in carry-on bag.


Medical Treatment: I give permission for Samaritan’s Feet representatives to provide or arrange for emergency care for me, and to arrange for transport to an emergency center for treatment. I consent to medical treatment deemed immediately necessary or advisable by a physician if I am unable to act on my own behalf. I further understand that Samaritan’s Feet is not responsible for payment for such medical treatment.


Photograph or Digital Image Permission: I give permission for Samaritan’s Feet to use, without limitation or obligation, photographs or other media that may include my image or voice to promote or interpret Samaritan’s Feet programs.


Release from Liability: I understand that accidents may occur during my volunteer activities. By signing below, I release the Samaritan’s Feet, its agents, directors, consultants, and employees from all liability based on any damage, loss or injury, whether it is the result of ordinary negligence or otherwise, caused to me or my dependent from participation as a volunteer.

Checking the box below and giving the date serves as your signature. By doing so you are agreeing to the following: I, hereby agree to the terms listed on this page including Conditions of Volunteer Participation and Release from Liability, Background Certification, Volunteer Terms, Property Loss, Baggage, Medical Treatment, Photograph or Digital Image Permission, and Release from Liability
Date

Additional Documents

Personal Testimony: Take time to tell us who God is and what God has done in your life, as well as why you feel called to a particular project. Upload a one-page personal testimony document.
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Please upload a copy of your passport. Make sure that the Passport Number and all content is readable in your image.
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