Internship Application

Personal Information *
Personal Information
Address
Address
Phone Number
Phone Number
Emergency Contact
Emergency Contact
Emergency Contact Number
Emergency Contact Number
Secondary Emergency Contact
Secondary Emergency Contact
Secondary Contact Number
Secondary Contact Number
Church Address
Church Address
Church Phone Number
Church Phone Number
Pastor Phone Number
Pastor Phone Number
Pastors Number
I, the undersigned, (if accepted for internship) to adhere to all policies of Open Hearts Ministries. I agree to follow all guidelines set forth by the ministry including dress code and integrity. I acknowledge that if I fail to do so, there will be consequences for these decisions that may result in termination of my internship with Open Hearts Ministries. Termination of Internship will result in immediate dismissal at which time I will return to the United States at my own expense with no refund of any part of the cost of Internship. Open Hearts Ministries does not provide insurance of any kind for travel to Nicaragua. This includes health insurance, and/or travelers insurance. Each traveler is responsible for determining the level and type of coverage needed for their travel and stay in Nicaragua. Travelers Statement: I know it is my responsibility to determine if any insurance needed for my travel to Nicaragua. I hold Open Hearts Ministries any affiliates, board members, officers, employees and volunteers harmless due to any loss or illness that could occur while traveling to, during my stay or traveling from Nicaragua.
Date
Date