Guest Information Form

Please submit this form to at least 30 days prior to arrival.

Name of Church (if coming with a church group): ______

Address of Church: ______

Please provide the names (as they appear on passports) of all visiting guests:

First Name / Middle Name / Last Name / Date of Birth / Passport Number / Passport Expiration Date / Traveler Insurance*
Y or N

*Traveler Insurance refers to extended medical insurance to cover limited services and med evacuation expenses should you become ill in country. This is provided by Christianville and included in your room and board fees.

Main Contact Person for your group: ______

Email: ______

Phone: ______

Address: ______

TRAVEL DETAILS

If members of your team are arriving on separate flights please include the travel information for each arriving guest:

Airline and Flight Number: ______

Arrival Date and Time: ______

Departure Date and Time: ______

Trip Details:

Tell us more about your plans and expectations for your upcoming trip so we can help you serve!

What activities do you have planned during your stay at Christianville?(note: if you need help planning and sourcing supplies for a project, please complete and submit the Project Planning Form)

Please provide details:

______

______

______

Will you require any transportation during your stay? (other than to and from the airport). Please provide details on where you will need to travel, on what days, and for how many people.

Dates to Travel outside of Christianville: / Times of Travel: / Destination(s): / Number of Passengers:

Special Needs:

Our staff works hard to provide safe and comfortable accommodations for all of those visiting Christianville. We recognize some of our guests have special needs, and while we can’t accommodate them all in Haiti, we certainly will to our best to assist all of our guests in order to maximize their ability to serve while staying with us.

Please indicate any special room requests for you or members of your team:

______

______

Please share any food allergies or special dietary needs that you or members of your team may have:

______

______

Do you or any of your team members have any physical limitations or conditions we need to be aware of?

______

______

Are there any other allergies you or your team members have that we should be aware of?

______

______

Do you have any additional requirements the team at Christianville needs to be made of in preparation for your stay with us?

______

______

Gifts Assessment

God has given everyone both physical and spiritual gifts that can be used to expand the Kingdom. Everyone can contribute. Please indicate the area(s) of service you would like to lend support during your trip to Christianville.

Office & Administration: (check all that apply) / Evangelism: (check all that apply)
______General Office Support / ______Sharing Your Testimony
______Computer Technician & Support / ______Adult Bible Study
______Computer Programming / ______Youth Bible Study
Medical Support: (check all that apply) / ______Children’s Bible Study
_____ Doctor ______Nurse / ______VBS program planning
_____ Dentist ______ Hygienist / ______Visiting/Praying with Sick & Elderly
_____ Optometrists ______Optical Assistance / ______Preaching to Groups
_____ Pharmacy ______Dental Assistant / ______Leading Prayer Groups
Maintenance/Construction (check all that apply) / Farming/ Landscaping: (check all that apply)
______ Cement Work ______Electrical / ______Livestock Care
______ Carpentry ______Welding / ______Aquaculture
______ Plumbing ______Diesel Maintenance / ______Crop Planning, Planting/Production Design
______General Auto Repair / ______Livestock Marketing
______Landscape Maintenance/Design
Other Duties: (check all that apply)
______Sewing classes
______Assisting the elderly
______Assisting in the School System (art, music, etc.)

Please list any other areas of expertise or talents that you would like to share:

______

______

PLEASE COMPLETE & RETURN THIS FORM, AT LEAST 30 DAYS BEFORE YOUR DEPARTURE.

Email to Guest Services Administrator at:

In order to better serve you in the future, please tell us more about you!

Tell us more about you: / YES / NO
Is this your first mission trip?
Is this your first trip to Christianville?
If no, number of previous visits to Christianville:
Do you receive our newsletter?
Would you like to receive our E-Newsletter?
Would you like information about partnership opportunities?
Would you like information about volunteer opportunities?
Do you sponsor a child?
If Yes, what is the name of your sponsored child?

Please provide us the best email address to stay in contact with you:

QUESTIONS:

Christianville Foundation, Inc. - PO Box 1056 Palatka, FL 32178

Contact our Guest Services Administrator at with questions.

“Sharing Christ’s Love in Haiti”

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