Skip to form
Contact Information:
Your Name (As in Passport)
*
Email
*
Phone number
*
Date of birth
Month
/
Day
/
Year
Job title
City
*
State/Region
*
Mission Trip Information:
Mission Trip Dates:
*
Please Select
May 15th - May 22nd, 2025
October 4th - October 11th, 2025
November 29th - December 6th, 2025
Serving Ministry
*
Please Select
Surgery
Primary Care
Dental Clinic
Pharmacy
Construction
VBS
Logistics
Additional Information:
Are you currently active in church?
Please Select
Yes
No
What is your church's name?
Do you have any allergies?
If you do, please share that information with us.
Are you currently taking medications?
If you do, please share that information with us.
Emergency Contact Information:
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please, upload the following documents:
Passport Information Page
*
Parental Consent Letter
You can find a template
here
Copy of Diploma
Copy of Professional License
To finish, please check off the following boxes to which you apply.
I have read and agree with Rice Foundation's
Terms Of Service.
*
I have read and agree with Rice Foundation's
Policy for Volunteer Service.
*
I have read and agree with Rice Foundation's
Waiver of Responsibilty and Assumption of Risk.
*
I declare that I am 18+ years old and am therefore capable of applying without having to send an additional
parental consent document.
Submit