All application submissions and questions may be sent to: CHECKLIST

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1 Dear Vlunteers, Thank yu fr yur interest in the Kids Arund the Wrld playgrund build trip. We are excited fr the pprtunity t wrk alngside yu t impact the lives f these children. The need there is tremendus s we appreciate yur help! T jin us n this prject, please cmplete the fllwing applicatin in its entirety and it t the San Clemente ffice n later than Nvember 1, All applicatin submissins and questins may be sent t: erikd@kidsarundthewrld.cm. CHECKLIST Please cmplete the Kids Arund the Wrld applicatin included in this packet and the fllwing items by Nvember 1, 2012: v Persnal Details v Land Package/Flights/Payment v Medical Insurance Cnfirmatin v Release Frm (with Witness signature) v Cntract v A clear cpy f yur passprt (we MUST have a cpy f yur passprt n file) v Nn-refundable $200 depsit (may be paid by check r credit card) Fr yur reference, please save a cpy f this applicatin befre sending it t us. PASSPORT INFORMATION: (If yu DO NOT have a passprt, please get ne immediately!) Passprt applicatins are available at majr pst ffices. Please allw plenty f time and fllw the instructins carefully. Passprts are required nly if yu are ging ut f the cuntry. If this trip is nt in the USA, we MUST have a clear, readable cpy f yur passprt included with yur Applicatin Frm. If yu need t get a passprt r are renewing yur passprt, please include a nte n yur applicatin stating that yu have applied, r have sent yur passprt in, fr renewal. (Nte: Passprts MUST be valid fr six mnths AFTER the trip ends. If yur passprt is due t expire befre six mnths prir t the trip ending date, yu will need t apply fr a new ne.) Recmmended immunizatins accrding t are: Hepatitis A; Hepatitis B; Typhid; Rabies Measles, Mumps, Rubella (MMR): 2 dses recmmended fr all travelers brn after 1956, if nt previusly given Tetenus-Diptheria: Revaccinatin recmmended every 10 years PLEASE cntact yur healthcare prvider fr his/her recmmendatins. 1

2 SUPPORT RAISING Supprt raising is a great way t get yur family, friends and cmmunity invlved! Whether yu desire t raise funds r simply share abut yur trip, we have a few suggestins hw t spread the wrd! SUPPORT LETTERS: Taking the time t write a cncise, ne-page letter that shares yur heart and details abut yur trip is time wrth spent. In the digital-age we live, sme peple really appreciate having tangible crrespndence via the mail. Let us knw if yu wuld like t prvide with yur letter small reply envelpes fr ptential dnrs t use. We wuld lve t supply yu sme! WEBPAGE: Speaking f the digital age, hw abut creating an nline webpage where yu can raise funds directly twards yur trip? Sunds easy, right? It is! Just cpy/paste the link ( int yur web brwser, click n Get Yur Own Page, and start raising supprt tday! Yu will receive a custm web address that yu can , Tweet and link t Facebk! DON T FORGET, yu need t submit yur applicatin and pay yur depsit BEFORE yu create yur page. We will immediately set up an accunt fr yu in ur nline database and then yu are FREE t set up yur webpage with GrupRev! AFTER yur page is created, us the link and we will mnitr all yur dnatins! T see an example f a past participant s webpage, check this ut: ONE LAST THING. Please make sure yur dnrs make checks payable t Kids Arund the Wrld s they are eligible t receive a tax deductible receipt. Dnrs mailing checks need t include a separate sheet f paper that states yur name and trip name. We must receive all dnatins in yur name at least 2 weeks BEFORE departure. Any dnatins received in yur name AFTER the deadline will g twards the verall cst f the trip and NOT yur persnal trip cst. Please cntact us anytime t get an update n yur accunt balance. We are happy t prvide yu with the names f yur supprters s yu may thank them! 2

3 PERSONAL DETAILS Applicatin Deadline: Nvember 1, 2012 Name: (as it appears n yur passprt): First Middle Last Address: Street number & name Hme Phne: City ST Wrk Phne: Cell Phne: f Birth: / / Passprt # Expiratin : T-Shirt Size: S M L XL XXL Zip XXXL All passprts must be valid at least 6 mnths AFTER trip ending date Any medical cnditins KIDS shuld be aware f? D yu have building experience? (please explain) Emergency cntact name(s) Phne # Phne # Hw did yu hear abut this trip? Family and friends can sign up t receive trip updates! 1. G t and chse Get Invlved and select Newsletter Signup 2. Have them enter their address and select yur trip (Cuntry Mnth Year) 3. They will receive daily updates and pictures while yu are away it s that easy! NOTE: Yu re emergency cntacts will autmatically be added t yur trip updates. 3

4 LAND PACKAGE Single Occupancy $ N/A $ Duble Occupancy (Airfare nt included) The land package includes: The abve amunts are apprximate csts fr the land package and is subject t change. The land package includes rm and bard, KIDS t- shirts, in-cuntry transprtatin, team pht/picture bk and Emergency Evacuatin Insurance. FLIGHTS Kids Arund the Wrld is purchasing flights fr this trip. If yu have a special circumstance and need t purchase yur wn tickets, please cntact Juliette befre ding s. (NOTE: Trip cst des nt cver the cst f checked bags) PAYMENT This applicatin MUST include a $250 nn-refundable depsit Credit Card Infrmatin: Number: / / / / Exp. : CVV Cde: (3 digit cde n back f card) NAME: (as it appears n card) SIGNATURE: TODAY S DATE: * I give Kids Arund the Wrld permissin t charge my credit card as charges are due. Signature (Please nte: The $250 dwn payment will be charged nw. Airline and ther pre-paid csts will be charged when due. The remainder f the csts will be charged 2 weeks befre the trip.) If yu are uncmfrtable filling ut yur credit card infrmatin n this frm, please call us within 48 hurs f submitting this applicatin t cnfirm yur reservatin with a credit card number. Yur place n the trip is nt guaranteed until we have yur depsit. Please initial abve t give us permissin t charge yur credit card nce yu call. If yu are raising supprt fr this trip, we must still receive payment. If desired, yur depsit and ther prepaid csts that yu pay will be returned t yu if all yur funds cme in. Thank yu fr yur understanding. Please make checks payable t Kids Arund the Wrld 4

5 MEDICAL INSURANCE CONFIRMATION I am persnally cvered fr freign travel by the fllwing medical insurance plan: Full Name Insurance Cmpany: Plicy Number: I verify that this plicy prvides cverage fr me while traveling utside f the United States and will be in effect while I participate in the Kids Arund the Wrld trip t: _ n the fllwing dates: t. Cuntry Name Beginning Applicant s Signature: Ending : If participant is under 18 years f age, parent r guardian signature is required. Parent r Guardian Signature: : IMPORTANT: All team members MUST have active medical cverage. In the event that yur insurance des nt cver yu in the cuntry where the build will take place, please cntact yur insurance agent t btain shrt-term medical/travel cverage fr the duratin f the trip. Yu can als btain shrt-term cverage nline at 5

6 RELEASE FORM I, in cnsideratin f the benefits derived frm my participatin in the prject trip t Full Name administratively rganized by Kids Arund the Wrld (hereafter Cuntry Name referred t as KIDS) n / / t / / d hereby release, acquit, and frever discharge KIDS, its emplyees, fficers, directrs and representatives frm any and all manner f suits, actins, claims, demands, and liabilities either by me r any and all persns having interest in me, fr any and all injuries, illnesses, lsses r damages I might incur n r in any way relating t my participatin in this trip, withut limitatin whether in the USA r in any freign cuntry. I recgnize that the cnditins in sme f the places t which I travel are nt f the same standard as the cnditins t which I am accustmed (i.e. plitical envirnments and judicial systems). I further realize that there are certain health and detainment risks as well as ther risks t me and my prperty, and I enter int participatin in this trip with awareness f thse risks. I understand that this dcument cnstitutes a full and cmplete waiver f all pssible claims, including claims fr negligence in persnal injury r prperty damage, arising ut f my participatin in this trip. N prvisin f this dcument shall, in any way, limit my right t make claims against persns ther than KIDS, its directrs, fficers, emplyee and representatives. Phtgraphic Release. I grant and cnvey unt KIDS all rights, title and interest in any and all phtgraphic images and vide r audi recrdings made by KIDS during my wrk n this prject including, but nt limited t, any ryalties, prceeds r ther benefits derived frm such phtgraphs r recrdings. Applicant s Signature If participant is under 18 years f age, parent r guardian signature is required. Parent r Guardian Signature Required fr All applicants- This Release frm must be witnessed by a nn-family member 18 years r lder WITNESS: Applicant s Signature 6

7 CONTRACT PAYMENT INFORMATION Yur place n the team is secured when yu submit this applicatin alng with yur $200 nn-refundable depsit. This depsit cunts tward the ttal cst f yur trip. As sn as we receive yur applicatin and $200 depsit, we will bk yur flights. We will purchase yur airline tickets n yur behalf and charge yur credit card r ask yu t submit a check as a dnatin fr the cst f the travel expenses and ther pre-paid csts (i.e. in-cuntry flights, visa fees, r any ther pre-paid items). Tw weeks befre the trip date, yur credit card will be charged, r we will ask yu t submit anther check, fr the remainder f the trip csts. If yu are asking friends and family t help with the cst f yur trip, we must receive all dnatins in yur name n later than 2 weeks BEFORE yur departure. Any funds received AFTER this deadline will g twards the verall csts f the trip, nt yur persnal trip cst. AGREEMENT By cmpleting this cntract, I agree t accept the terms set frth, in rder t cmply with the gvernmental effects new rules have n ur peratin. By agreeing t this cntract, I am indicating that I wuld like t participate n a playgrund build and/r ministry trip with Kids Arund the Wrld, and I plan t either dnate funds t cver my expenses fr the trip, r raise dnatins accrdingly. I realize that all checks shuld be made payable t Kids Arund the Wrld and sent t 1046 Calle Recd, Unit F, San Clemente, CA 92673, and that all mnies will be earmarked at Kids Arund the Wrld fr my expenses related t this trip. Kids Arund the Wrld may need t increase csts upn ntice t participants. I understand that I am submitting a $200 nn-refundable dnatin as a depsit fr my participatin. I will prvide any pre-paid csts, (i.e. visa fees), alng with any airline tickets fr my travel purchased n my behalf by Kids Arund the Wrld. I will pay the remainder f the trip accrding t the terms specified n the applicatin. I als acknwledge and agree all funds received by Kids Arund the Wrld fr this trip are cnsidered tax-deductible dnatins, and are therefre subject t IRS regulatins fr such dnatins. In the event the funds raised thrugh dnatins frm thers fr my trip csts exceed my ttal csts, I agree t have thse funds applied t the verall team csts fr the trip in which the funds were riginally intended. Hwever, if desired, I can request t have funds I have paid persnally refunded, up t the ttal excess amunt. I understand that any refunded mnies wuld n lnger qualify as a tax-deductible dnatin. I understand any funds received by Kids Arund the Wrld after the 2-week pre-trip deadline will NOT g int my trip csts but will g int the verall csts f the trip and therefre wuld nt qualify t be refunded. In the event that I am unable t participate in this event, either because f my decisin r because the trip is cancelled r pstpned due t events beynd the cntrl f Kids Arund the Wrld, I agree that any nn-recverable related csts Kids Arund the Wrld incurred n my behalf will be my respnsibility. I understand that in gd faith Kids Arund the Wrld will attempt t help me schedule anther trip in which I can apply the remaining dnated funds. But if rescheduling my trip is nt feasible, all mnies received n my behalf fr this trip must be treated as a dnatin t Kids Arund the Wrld, and is therefre still eligible fr cnsideratin as a tax-deductible gift. Signature f Applicant Parent r Guardian Signature (If applicant is under 18 years) 7