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are you ok with sharing a room?

on a scale of 1-10, how adventurous are you? (1= barely, 10=very)

how I heard about this trip...

name, email and phone number of 2 personal references

can you commit to filling two suitcases with donated items from our "donation" list? (Last year we brought 22 suitcases! This year we want to double it)

what gifts and talents do you have? (handyman, singing, crafty, dance, etc)

who is someone in your life that you respect a lot, and why?

what personal expectations do you have for the trip? what would you like to get from it?

what are your personal strengths and weaknesses?

why have you decided to participate in this trip?

Write a brief, yet fun, autobiography that will help us get to know you better

do you think you could work well in a variety of age group settings?

do you have any previous experience traveling to a third world country?

Have you ever...
(please write all that apply)
Served time in a detention center or jail?
Been convicted of a crime?
Been involved with illegal drugs?
Been involved with a cult or the occult?
Had psychiatric care?
Taken medication for behavioral issues?

Name, email and phone number of the person you are currently closest with that will not be on the trip (spouse, parent, friend, sibling, etc)

emergency contact (name, address, phone, email)

Passport number and expiration

allergies or dietary restrictions?

are you currently on any medications? Please provide the names and dosage (will only be used for reference in case of emergency)

t-shirt size

insurance company & policy #

phone number

marital status


email address



home address

Simply Love 2015 application

insert name as seen on passport




before your shoot