CCFA Application Form

Personal Information

Please enter your name and address as they are listed for your debit card, credit card, or bank account.

All fields in bold are mandatory.

Last name:

First name:

Gender Female Male

Date of birth: (D/M/Y)

Nationality:

Address:

City:

State/Province:

Country:

ZIP/Postal Code:

Email:

Verify email:

Home phone:

Cell phone:

Work phone:

Fax:

Emergency contacts and information

Name 1:

Home Phone 1:

Address 1:

Cell Phone 1:

Fitness Adventure

Desired Fitness Adventure:

Desired # of weeks:

Please explain why you chose this particular Fitness Adventure

What are your fitness goals?

Please describe your past fitness history (ie. Do you workout at a gym regularly, somewhat, or not at all; have you had personal training before; what types of activities do you do to stay active? etc.)

Do you have any health problems/past history of surgery or special medication that you are currently taking?

Are you interested in studying Spanish at CISA – Christian Immersion Spanish Academy? Yes, No, Possibly

Are you interested in volunteering at the Voz Que Clama Mission? Yes, No, Possibly

Are you interested in doing any tours? If so, what would you like to do? Yes, No, Possibly

Travel details (If known)

Flight Details

Please provide flight details later if unknown at time of application.

Arrival date(m/d/y):

Arrival time:

Airport / City:

Airline / Flight #:

Last City of Departure :

Departure date(m/d/y):

Departure time:

Airline / Flight #:

Require airport pick up and drop off? Yes No

General

How did you find out about CCFA?:

Comments or Questions

Verification

Verification Information

Type the characters you see in this picture. This ensures that a person, not an automated program, is creating this application, and also that YOU HAVE READ AND AGREE TO THE POLICES STATED IN THE PRICING POLICIES AND PROCEDURES

Picture

Characters: