Medical Questionnaire

NOTE: Each applicant must complete the entire Medical Questionnaire for each trip regardless of prior travel with the Passion Center mission team. PLEASE READ CAREFULLY: The Passion Center Malawi Mission Project/Trips are extremely strenuous and stressful. The trip includes long airline flights and van/bus rides of many hours. Travel time to Malawi can be in excess of 48 hours in duration. Travelers are almost always required to carry their own luggage. Restrooms are not always accessible. It is important to be careful about what we eat due to possible foodborne illnesses. The food is generally high in fat, carbohydrate, and sodium content. Fruits and vegetables may not be available. The housing and meeting rooms may not have air conditioning and may not have adequate heating. There can be considerable amounts of walking between housing locations as well as walking to areas in the communities we serve. Work projects may be strenuous. The health conditions of the people we serve may be poor. Bloodborne and airborne communicable diseases such as HIV/AIDS and Tuberculosis are prevalent in the communities we serve. The mosquito-borne disease of Malaria is also prevalent in the communities in which we are traveling. All of these factors may aggravate certain health conditions and the medical facilities in Malawi may provide inadequate care. We may request a medical release statement from your doctor if indicated. Recommendation: Obtain a recent Tuberculin Skin Test (TST) or a Blood Assay Test (BAT) (i.e. - QuantiFERON Gold or T-SPOT) for Tuberculosis. *Due to the risk of possible exposure to Tuberculosis while in-country a repeat TST or BAT should be obtained 8-10 weeks after your return from Malawi. By signing this document, I acknowledge that I have read and understand the information provided in this waiver, and I certify that the information provided is true and correct to the best of my knowledge.

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Thank you, your questionnaire has been submitted. For further questions or information, contact Eric Sythoff at esythoff@passioncenterforchildren.org

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