Heal International Medical Missions
Bringing Healing To Hurting Bodies and Souls
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Upcoming Surgical Medical Mission: Currently GUATEMALA AUGUST 5-10TH, 2024 Cutervo Peru, October 5th-12th for 2024, All interested in these upcoming medical missions please contact Lupita @ 956-648-1186, medical volunteers needed all areas! Going to serve is a blessing to others and yourself!
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Upcoming Trips
Agua Dulce Panama – Spring 2022 Date TBA
Ouanaminthe Haiti – November 13-18, 2021- Medical Volunteers Needed
Dominican Republic, Santo Domingo – 2022
Peru – November 2022
Quetzaltenango, Guatemala – Summer 2022
Quiche, Guatemala – Fall 2022
RioHacha (Guajira) Colombia – Fall 2022
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Volunteer Application
Name as appears on passport
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Home Address
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Street Address
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Country
Date of Birth
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mm/dd/yyyy
Weight
International flight carrier requires amount of weight being transported.
Home Phone
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(###)###-####
Work Phone
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(###)###-####
Cell Phone
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(###)###-####
FAX
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Email
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Passport Number
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Country of Issue
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Expiration Date
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T-Shirt Size
Spouse's Name
Please fill in if you have a spouse
Emergency Contact Information
Emergency Contact
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Home Phone
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Other Phone #
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Relationship
General Questions
Do you have any physical limitations/illness/health issues that we should be aware of?
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Yes
No
If yes, please describe
Have you ever been charged/convicted of a crime?
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No
If yes, please explain
Please tell us which trip(s) you are interested in
Job Information
Job Title
Place of Employment
Work Phone #
Have you traveled with H.I.M.M. before?
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Yes
No
If yes, when?
Trip location and the date.
Please list skills that you would be able to offer to the team:
Would you be available to attend a mandatory team meeting prior to travel?
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Yes
No
If no, please explain
Comments or Concerns
How did you hear about HIMM?
I have read HIMM’s Information and Guidelines for Mission Teams.
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Yes
No
General Release
In consideration of Heal International Medical Missions arranging a volunteer assignment for me, I hereby release and forever discharge Rio Life Church or any board members from any and all claims that I may have, of whatsoever nature, relating to my time as a volunteer with Heal International Medical Missions. This includes, but is expressly not limited to death, bodily injury, personal injury, property damage, theft of property, economic loss or any other damage.
I have read and agree with the above statement:
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