JCLWM Team Application
Return by 11/15-17 to ) or to
Sharon Marsh, 4116 E. Latoka St. Springfield, MO 65809
Name: (As it appears on your Passport) DOB:*Passport Number: / Expiration Date:
Street Address: / Phone:
City: Zip: / Emergency Contact:
Email Address: / EC Phone: Relationship:
Yes / No / Participant and Medical Questions
Are you willing to be responsible for your airfare to and from the Dominican Republic? (Approx. $815.00)
Are you willing to be responsible for making your own flight reservations?
Will you commit to having a current passport before the departure date? (Passport must not expire less than six months after date of return.)
What Living Waters for the World training have you had? Clean Water U JC Living Waters (Circle one)
In which area were you trained? When were you trained?
Which job would you be most comfortable doing? Education (102) Installation (103) (Circle one)
If you have not had Living Waters for the World training, will you commit to attending required training sessions?
Are you willing to attend a separate Spanish language and commit to learning some basic phrases?
Do you have any medical condition that would restrict your ability to sit for extended periods of time while riding in a bus or van? (i.e., motion sickness, etc.) Explain:
IF motion sickness is sometimes a problem for you, will you be prepared with the appropriate medication AND do you agree to notify the team leaders so appropriate provisions can be made?
Are you willing to take all of your prescription medications in their original, labeled containers as required by TSA?
Are you allergic to any foods, medications, or naturally occurring flora or fauna? If so, please list:
Are you able to walk on rough, uneven surfaces for distances of up to two - three miles?
Electricity is not always available 24 hours a day. If this would be a problem for you, how will you handle it?
Are you willing to follow Team Leaders’ instructions and/or recommendations?
Can you remain joyful and or pleasant under difficult circumstances, assist other team members, and maintain a sense of humor?
Signature: Date: