Medical Mission Application - The Castañeda Kids Foundation

Session Preference

Session 1: January 25 - February 1, 2026
Session 2: February 2 - February 9, 2026

Please Select a Session Preference

Personal Information

Legal First Name

Legal Middle Name

Legal Last Name

Nickname/preferred

Date of Birth

Phone

Address Line 1

Address Line 2

City

State

Zip Code

Professional & Health Profile

Doctors and Nurses Only: Resume or CV
(Accepted formats: .pdf, .jpeg, .jpg)

Doctors and Nurses Only: Diploma
<(Accepted formats: .pdf, .jpeg, .jpg)

What is your professional title?

What is your current job?

What kind of professional certificates/licenses do you have that would be relevant to this Medical Mission?

Do you have any health related problems or physical limitations including allergies that might restrict or limit participation during this mission (note this will not exclude you from being selected)?

Yes No

If so, please list.

Do you have any food allergies/restrictions?

Yes No

If so, please list.

Language & Travel Documents

Do you speak Spanish?

Do you have a passport?

Yes No

Passports must be valid for at least 6 months beyond the scheduled return date of the trip. If you do not currently have a passport, please enter 'None' in the following 4 fields.

Passport Number

Name as on passport

Country of issue

Expiration Date

Required for Everyone: Copy of Passport Main Page
(Accepted formats: .pdf, .jpeg, .jpg)

Insurance & Emergency Contacts

i Medical Insurance is provided as part of your fee. Please designate a beneficiary in case of emergency.

Beneficiary First Name

Beneficiary Last Name

Beneficiary Phone

Beneficiary Email

i Please provide an emergency contact who is not going on this trip:

Contact First Name

Contact Last Name

Phone

Additional Details (New Participants Only)

Have you ever participated in a Medical Mission before? If so, where and when?

Shirt

Men's Women's

Shirt Size (They tend to run small.)

Roommate preference (optional)

Agreement & Signature

If I am selected to participate as a volunteer with The Castañeda Kids Foundation, I will follow ALL of the policies and procedures established for the welfare of the group, follow instructions by the Team Leaders and accept all conditions that support the team's goals. Volunteers agree to adhere to staying within our established safe areas set forth by The Castañeda Kids Foundation. I also understand that the fee set forth by The Castañeda Kids Foundation will be non-refundable in its entirety. Special circumstances will be handled on a case-by-case basis.

Authorized Signature First Name

Authorized Signature Last Name

2026 Medical Mission Application

Session Preference

Session 1: January 25 - February 1, 2026 Session 2: February 2 - February 9, 2026

Personal Information

Professional & Health Profile

Language & Travel Documents

Insurance & Emergency Contacts

Additional Details (New Participants Only)

Agreement & Signature

Session 1: January 25 - February 1, 2026
Session 2: February 2 - February 9, 2026