MEXICO MISSION 2026 STUDENT PARTICIPANT FORM

Please put your STUDENTS NAME here as the "Participant". Parents are not the "Participant"! There is a place below for parent/guardian info!

Your name *

Last name

Email address *

Phone number *

Phone type

Mobile Phone Carrier? *

Address *

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

OTHER INFORMATION

WHAT SCHOOL ARE YOU CURRENTLY ATTENDING? *

WHAT WILL BE YOUR HIGH SCHOOL GRADUATION YEAR? *

STUDENT'S HEADSHOT PHOTO: *

.JPG format only! This photo will be used to introduce you to your 'prayer partner'. PLEASE do your best to upload a high resolution photo of YOU ONLY! Make sure your face is large and visible.

No file currently selected

Choose 1 file. Maximum file size 10 MB.

PASSPORT INFORMATION - PLEASE DO NOT SKIP

Since Mexico requires border crossing Visa's, we will need each students passport in advance of the trip or during the final mandatory Mexico meeting on March 22nd. EVERY year we have students that don't realize their passport has expired! RENEW ASAP if necessary or retrieve it now to complete this form.

DO YOU HAVE A CURRENT PASSPORT? *

WHAT IS YOUR PASSPORT NUMBER? *

Please take a moment to put your passport number below (write N/A if you don't have your passport yet).

WHAT IS THE EXPIRATION DATE ON YOUR PASSPORT? *

Write N/A if you do not have your passport yet.

FULL LEGAL NAME EXACTLY AS IT APPEARS ON YOUR PASSPORT *

Or as it will appear when you get it. THIS MUST MATCH YOUR PASSPORT

PARENT/GUARDIAN INFORMATION

Please put parents information here...NOT students. Students information should be at the top of this form.

PARENT/GUARDIAN FIRST AND LAST NAME: *

PARENT/GUARDIAN EMAIL ADDRESS: *

PARENT/GUARDIAN CELL PHONE NUMBER: *

SECONDARY EMERGENCY CONTACT FIRST AND LAST NAME: *

SECONDARY EMERGENCY CONTACT CELL PHONE NUMBER: *

SECONDARY EMERGENCY CONTACT-RELATIONSHIP TO STUDENT: *

(father, mother, guardian, aunt, uncle, etc.)

TENT ASSIGNMENTS AND WORKSITES

Please note: We are not always able to match a student's friend requests, but we try our best to pair each student with at least one friend either in their tent assignment, house building worksite, or both! Student's may submit up to three (3) friend requests. Keep in mind that our house building teams will always pull together from different grades.

FRIEND REQUEST #1 - First and Last Name:

FRIEND REQUEST #1 - Grade in School:

FRIEND REQUEST #2 - First and Last Name:

FRIEND REQUEST #2 - Grade in School:

FRIEND REQUEST # 3 - First and Last Name:

FRIEND REQUEST #3 - Grade in School:

SHARE WITH US YOUR HEART FOR THIS TRIP

Why do you want to be part of this Mission Trip to Mexico? What are you looking forward to? We get to share this with your prayer partner *

HOW MANY TIMES HAVE YOU BEEN TO MEXICO WITH US? *

This is my first time

Once before

Twice before

This will be my third trip

Fourth time!

Fifth time!

HOW WOULD YOU RATE YOUR SPANISH SPEAKING ABILITY? *

IS THERE ANYONE YOU KNOW THAT WOULD MAKE A GREAT ADDITION TO OUR ADULT LEADER TEAM? IF SO, PLEASE PUT THEIR NAME AND CONTACT INFO. BELOW:

STUDENT HEALTH CONCERNS

Does this student have any life threatening allergies? *

Yes

Does this student carry an EpiPen? *

Yes

If YES, please name/explain any severe allergies:

Does this student have a RESCUE INHALER? *

Yes

Will this student be taking any medications on this trip? *

Yes

If YES, please list all medications below along with the frequency/timing (i.e. 1 tablet twice a day). ALL medications MUST be turned in at check-in before departure in their original containers (with student's name shown on the prescription).

OTHER IMPORTANT INFORMATION

Health or Other Personal Concerns. Please list personal health concerns or physical limitations we should know about, beyond allergies and medications noted above (indicate "none" if appropriate) *

Any additional notes or concerns for us? Please share with us anything you want us to know!

PERMISSION AND ACKNOWLEDGEMENT

I give permission for the above named student to attend Student Ministries Mexico Mission Trip April 4th - April 10th, 2026 sponsored by Community Presbyterian Church (CPC). I have read, understood, and signed CPC's Liability Waiver and Medical Release Form for the 2026 calendar year, and all medical and contact information on that form is current and accurate. I also agree to come pick up the above named student, or pay the expense of having him/her sent home, at any time due to inappropriate behavior, disrespectfulness or due to the possession of drugs, alcohol or weapons. This includes any and all vaping/smoking materials.

BY ANSWERING YES, YOU AGREE TO THE ABOVE STATED TERMS AND RELEASE *

Yes

CPC Danville
info@cpcdanville.org
925-837-5525