Medical Mission Application

Medical Mission Application

Medical Mission Team Application

Please print and complete all fields. Where a response is not available please put N/A.

When you have filled out the application, be sure to mail us all required supporting documents along with a copy of your confirmation email to:

88 Country Mile Road
Phillips Ranch, CA 91766

Your application will not be considered complete until we receive all supporting documents.


Personal Profile

(As it appears on your passport)

(if different from above)

(What city would you like to depart from?)

Emergency Contact

(This person's relationship to you)

Organization Information

First time applicants, please complete this section


(Please list at least two references here. OGWA SYNERGY USA may contact these references)

Background Information

Please indicate what language(s) you speak.  Separate each one with a comma.

List any countries you've visited.

Release of Liability


Release of Liability

I have chosen to be part of a medical mission trip by establishing a voluntary relationship with OGWA SYNERGY USA. I understand that I am a volunteer and not an employee, authorized agent or any other official representative of OGWA SYNERGY USA. I understand that there are many risks involved in my voluntary service and hereby accept any and all risks either known or unknown as my own, voluntary act.

I agree to hold the OGWA SYNERGY USA harmless from any form of damages resulting from any loss, injury or death, which may result from or arise out of my voluntary relationship with OGWA SYNERGY USA. I understand that no payment to hostage takers will occur.

I release OGWA SYNERGY USA for myself and for my heirs and those responsible for my estate.


Mission Agreement

If I am selected as a team member for this short-term missions trip, I agree to cooperate whole-heartedly with my leader(s) and team members to accomplish the stated goals of the project. I will work with the team to raise prayer and financial support for the team and related expenses.

I accept, without reservation, the decision of the program coordinator and the team leader regarding my participation, or non-participation, on this trip.

I fully understand that my role as a team member is:

  • To raise all my required financial support before the required deadline
  • To develop a team of supporters to share in this experience
  • To fully complete and participate in all pre and post trip training and evaluation materials sent to me by OGWA SYNERGY USA
  • To serve my team and the people of the country I am visiting without passing judgment
  • To submit to my team leadership



(Please make sure all are enclosed. We strongly advise that you make a copy of thesedocuments for your own records and reference)

______Fully completed Application Form
______Fully completed Medical Profile
______Fully completed Background Check Consent Form
______Read & Signed Release of Liability
______Copy of Passport Identification Page
______Recent Snapshot of yourself
______Enclosed $400 Deposit (payable to OGWA SYNERGY USA)*


  • The deposit will be returned in full, up to six months prior to departure, if for any reason you are unable to participate.
  • Application deadline is four months prior to departure, after which time we cannot guarantee a spot or trip cost. After the deadline you must have a valid passport in hand and be willing to accept any applicable increase in airfare.
  • Trip cost and airfare cannot be guaranteed if payments are not received by their due dates.


Send all supporting documents to:

88 Country Mile Road
Phillips Ranch, CA 91766