Which trip are you interested in? *
Select… Nicaragua | February 7-14, 2026
Phone Number *
Phone type Mobile Home Work Other
Marital Status *
Select… Child Married Single Divorced Widowed Engaged
Indicate your t-shirt size... *
Do you have a passport? *
Select… Yes, I have a valid passport. No, I don't have a passport.
Please list the full name on your passport or birth certificate. *
List your full name as it appears on your passport or birth certificate. This should include any middle name, prefix, or suffix.
Are any other family members participating in this trip? *
Select… Yes No
Emergency Contact Name and Relation *
MUST be someone who is not traveling with you and has a valid passport.
Emergency Contact Address *
Please rate your present health *
Select… Good Average Poor
Are you presently under the care of a physician? *
Select… Yes No
Any Dietary Concerns
i.e. lactose intolerant, vegetarian, etc.
Which campus do you attend? *
Select… Plymouth Brighton
Please share a personal statement of your relationship with Jesus Christ *
Include the approximate date you became a Christian
Please indicate which areas you have any skills, training, or experience in: *
Check all that apply
Do you speak a second language? *
Select… Yes No
Have you been on other Outreach Trips with NorthRidge? *
Select… Yes No
Why did you decide to go on this trip? *
How does your family feel about you going on this trip? *
How do you resolve conflicts with others? *
How would your experience strengthen your relationship with the Lord? *
What is your greatest concern about this trip? *
Submit
