Expeditions Application

Incoming students are required to make a nonrefundable $200 deposit for the expedition. You can send in a check by mail or call our office to make a credit card payment over the phone. This deposit must be received within 10 business days of submitting your application to reserve your spot. Make checks payable to "Gordon College" (we cannot accept checks made out to La Vida) and mail to:

La Vida at Gordon College
255 Grapevine Road
Wenham, MA 01984

Please put your name and trip date in the memo. La Vida will contact you to confirm your enrollment after we have received your application and deposit.

For international students who cannot send a check in the mail, please contact the La Vida office at 518.891.4188 or email to make alternate arrangements.

Please Note:
This form will timeout and erase answers after 20 minutes.


College Expeditions Application

Before you fill out this application, please read our cancellation and refund policy (http://www.gordon.edu/lavida/college/costs). By submitting this application, you agree that you have read and understand this information, and you agree to abide by the refund policy as stated. (Current Gordon College students who have registered for a La Vida Expedition are already bound to the refund policy by the Gordon College catalog.)

1. Year in college at time of registration

2. First Name

3. Last Name

4. Nickname

5. College ID number (given to you by admissions)

6. Home Address

7. Home Address (line 2)

8. City

9. State

10. Zip

11. Country

12. Home Phone

13. Cell Phone

14. Email (only used for expedition communication purposes)

15. Household/parent or guardian email (only used for expedition communication purposes)

16. Sex

Male
Female

17. Age

18. Birth date (mm/dd/yyyy)

19. Height

20. Weight

21. Course preference and availability for PED016 2015. ***The August trip is split into two departure dates (8/8 and 8/9) to accommodate the number of students. You will be notified of your departure date by email.

22. Specific patrol requests

Mountain
Canoe
Any

23. Reason for specific patrol request:

24. Major

25. Extracurricular activities:

26. Previous camping experience:

27. What three words best describe your temperament?

28. What three goals would you hope to accomplish during your La Vida experience?

29. How did you hear about and decide to apply for this Expedition? What is the main reason you want to go on the trip?

30. What gifts, talents, values, etc., would you bring to a La Vida small group?

31. Are there any special logistical needs, requirements or prayer requests for this upcoming experience?

32. On a scale of 1 to 10, 10 being the highest, rate yourself in health

33. On a scale of 1 to 10, 10 being the highest, rate yourself in physical strength

34. On a scale of 1 to 10, 10 being the highest, rate yourself in endurance

35. On a scale of 1 to 10, 10 being the highest, rate yourself in desire for spiritual growth

36. Due to the strenuous nature of the activities and remote environment, are there any physical, emotional or mental health concerns we need to be aware of?

37. Are you taking any prescribed medications?

38. Are you allergic to bee stings? (Yes/No/Severity)

39. If yes, do you carry an EpiPen for your bee allergy? (If yes, please note you must bring your own EpiPen in addition to the ones we carry in the first-aid kit.)

Yes
No

40. Do you have any special allergies or dietary needs? Please check all that apply. (We cannot accommodate food preferences, but we will work with you regarding medical dietary needs. Please contact lavida@gordon.edu)

Vegetarian
Vegan
Dairy-Free
Gluten-Free
Celiac
Food Allergies
Other

41. If you made a selection above, please explain the allergy and its severity:

42. I have read the cancellation and refund policy and agree to abide by that policy.

Yes