Trip Application
Join us on a service trip to Uganda!

Suggested Amounts

Personal Information

Passport Information

Medical and Emergency Contact Information

Spiritual/Church Information

General Questions

Application Agreement

I have answered these questions honestly and to the best of my ability. I understand I must be 18 years old, unless accompanied by a guardian. I understand that my $50 deposit is due with this application and that it is nonrefundable. If chosen for the trip it will go towards my trip cost.I understand all payments made towards my trip are nonrefundable. I understand that Simone’s Kids will review this application and may schedule a personal or phone interview for follow up questions. Please mail your deposit to Simone’s Kids, 202 Dallas HWY SW, Cartersville, GA 30120 or donate online and add a special note.

Billing Information (for $50 deposit)

  • Visa
  • Mastercard
  • American Express
  • Discover
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