Medical Mission

We invite you to complete an application to join the Diocese of Charleston Medical Mission. But before, please read the following statements thoroughly before applying for a mission trip:

Due to COVID-19, travel regulations to/from the US and Guatemala are changing often. Please see the latest from the U.S. Department of State:  

COVID-19 Testing Required for U.S. Entry

Effective January 26, the Centers of Disease Control and Prevention (CDC) will require all air passengers entering the United States (including U.S. citizens and Legal Permanent Residents) to present a negative COVID-19 test, taken within three calendar days of departure or proof of recovery from the virus within the last 90 days​. Airlines must confirm the negative test result or proof of recovery for all passengers two years of age and over prior to boarding. ​Airlines must deny boarding of passengers who do not provide documentation of a negative test or recovery.

Please see CDC’s FAQ for answers to questions about the new requirement for proof of negative COVID-19 test or recovery from COVID-19 for all air passengers arriving in the United States.


  • All applicants should complete this form in its entirety and then click "submit."  The application will be sent securely to Deacon Gabriel Cuervo, the medical mission coordinator.  If you are unable to attach a copy of the requested documentation to this form (attachment options are at end of the form), please send a copy to the following address:


Diocese of Charleston

Attn: International Ministries

901 Orange Grove Road
Charleston, SC 29407

or as an e-mail attachment 


  • You need to be mentally and physically fit to participate in the mission. (For example: walking up and down stairs several times at the three-story clinic; walking up and down hills and trails with no handrails; carrying your bag pack or carry-on to board the boats through docks that are unstable and missing slats).
  • You need to provide a SAFE HAVEN certificate and must agree to be screened by the Office of Safe Environment of our diocese. The Diocese of Charleston requires now that all participants attend a SAFE HAVEN training online. Please visit Attach the certificate to this application. 
  • You will need a passport for international travel that will not expire for at least six months after the returning date from the trip. Here is an excerpt from the U.S. State Department: "Some countries require that your passport be valid at least six months beyond the dates of your trip. Some airlines will not allow you to board if this requirement is not met."  It happened to one of our volunteers once and we do not want this to repeat. Please send a copy of your current passport to our office.  If you do not have one, you can get an application for a passport through your County Courthouse, local post office or online at 


**For Health Care Professionals Only: Due With Application**

  • The country of Guatemala changed the documentation required by foreign medical doctors participating in medical missions. Please send one copy of your current United States license to practice your profession and your diploma from the medical school (doctors ONLY) along with a copy of your passport to the Diocese of Charleston (or attach to this application). 


Dates of Mission Trip
Please write your name exactly as it appears on your passport

Are you a health care professional? *
Do you carry malpractice insurance?
Have you previously been on a medical mission trip? *
Date of Last Trip (Month, Day, Year)
Do you have a passport? *
If yes, please complete the following:
Expiration Date (Month, Day, Year)

Date of Birth (Month, Day, Year)

Has the Diocese of Charleston run a background check on you in the last three years ?
(If you are a parish volunteer, it is possible that you are already screened) *
Have you taken the SAFE HAVEN class or similar certification?
(If you are a parish volunteer, it is possible that you are already certified) *
Date of class (Month, Day, Year)
Do you speak Spanish? *
ONLY if you answered yes, describe your fluency please:

I can walk 1 mile before tiring. *
I can walk 1 mile up/down hills before tiring. *
Medical Information
You are responsible for bringing your own medical information with you on the trip.  This information includes, but is not limited to: name of physician(s), health insurance information, medical history, current medications, dietary restrictions, and allergies.

You are responsible for your own immunizations.  While it is not required, it is strongly recommended that you have an up-to-date tetanus immunizations.  We also recommend Hepatitis A & B.

Please pack a one week supply of all prescription and over the counter medicines that you will need.  Keep these in your carry-on bag.  Since brand names of drugs differ in other countries, it is recommended that you have the generic names of drugs listed on the bottles.

Emergency Contact Information

Electronic Signature


Assumption of Risk Agreement

Assumption of Risk and Release of Liability

In consideration of the Roman Catholic Diocese of Charleston and its agencies and personnel, in arranging and providing all the logistics of travel, housing, meals, etc., and for providing the opportunity for me to volunteer my services for a planned mission trip to San Pedro La Laguna and/or surrounding villages in Guatemala.
I hereby state the following:

a) That I am physically fit and have no medical condition that would prevent me from performing the volunteer services for which I am applying;

b) That I take full responsibility for obtaining all my immunizations and personally paying the costs;

c) That I am aware that there are hazards and risks to my person and property associated with the overseas short term missions activities for which I am applying. Such hazards and risks include, but are not limited to; death, disability, loss of ability to maintain earnings, loss of property, illness, disease, inadequate and /or unavailable medical services, weather conditions, trip delays, unlawful detention, terrorist acts, war, criminal acts, and wild animals;

d) That I agree to be solely responsible to provide and care for my own personal health, as well as my belongings.


I HEREBY ASSUME ALL OF THE RISKS set forth above, as well as any risks related thereto, which may result in injury, death, property damage, property confiscation, etc. and I agree to volunteer my services on behalf of the above mission, despite the hazards and risks set forth above.

I HEREBY RELEASE FROM ALL LIABILITY the Roman Catholic Diocese of Charleston (and its Bishops, agencies, employees, agents, and any affiliated organizations) for any and all claims for damages for personal injuries to myself and to my property or any damages resulting from delays in being returned to the United States.

I HEREBY AGREE TO HOLD HARMLESS and to indemnify and reimburse the Roman Catholic Diocese of Charleston (and its Bishops, agencies, agents, and employees and affiliated organizations) for any and all claims that are brought against the Diocese and its Bishops and agents, and for all expense (including attorney’s fees) that the Diocese may incur as a result of any claims presented against them, for any of my injuries and losses, or for any of my conduct related to said mission trip.
Electronic Signature