Sign up

Hearts United with Haiti

Below is our online application! It is the easiest way to sign up for one of the trips that we offer! If you are one that likes pen and paper, then this is the form for you: Paper Application

NOTE: Be sure to send in your $100 deposit to hold your spot. Just filling out the application does not guarantee you a spot on one of our trips.
(you can send it via regular mail to Hearts United with Haiti, PO Box 55, Morgantown, PA 19543 or you can donate online on our donate page)

Please take a few moments to fill out your personal and medical information and answer some questions about your personal journey of faith and comfort level in certain situations. Please also note that this application is specifically for our open trips. If you are attending one of our closed trips please contact your group leader for a link to your application.

Trip Applying For *

Part 1: Personal Information

First Name * Last Name * Address *

City * State * Zip Code *

Country (if other than United States) Phone number *

Email * Date of Birth MM/DD/YYYY * T-shirt Size *

In case of emergency please contact * Relationship to that person *

Phone number of emergency contact *

Part 2: Medical Information

Do you have asthma? * Yes No
If yes, indicate treatment

Do you have an allergy to any medication, food, bee sting, or insect bites, etc? * Yes No

If yes, please explain your allergy and treatment for your allergy

Are you currently taking any medications? * Yes No
If yes, what kind, how much, and how often?

Is there any other medical history we should be aware of?

Family physician's name * Family physician's phone number *

Date of last tetanus shot (must be within the last ten years) MM/DD/YYYY *

Part 3: Personal Reflection Questions

Tell us why you are wanting to go on this trip *

Do you consider yourself a Christian? * Yes No

If yes above, when/how did you come to know Jesus Christ as your personal savior? If no, what is holding you back? *

How does this relationship with Christ affect your life? *

How important is a daily devotional time/prayer time to you? *

What are you looking most forward to when on this trip? *
What are you NOT looking forward to on this trip? *

Have you been on a mission trip before? * Yes No

If yes, when and where?

Can you help with daily worship? * Yes No

If yes, how?

Please rate the following situations from 1 being least comfortable to 5 being most comfortable:
Sharing your faith * Praying out loud with someone *

Functioning with little sleep * Cramped living quarters * Sleeping on the roof of a house *

Showering with cold water * Sharing in the chores * Trying new foods *

Is there anything else we need to know to better assist you on this trip? (i.e.: “deathly afraid of spiders”, “loves to meet new people”, “has a real heart for the poor”, special skill?, etc…)

DO NOT MISS THIS: If you submit your application online do not forget to print this form out and fill it out before coming on your trip (and to send in your non-refundable $100.00 deposit):

Medical release, trip expectations, and liability release form