PERSONAL DETAILS Please Print Clearly

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1 Dear Volunteers, Thank you for your interest in the Albania Playground Build. We are excited for the opportunity to work alongside you for the kids of Albania. The need there is tremendous so we appreciate your help! To join us on this project, please complete the following application and return it to our office with a copy of your passport no later than January 31. If you have any questions filling out this application please dianah@kidsaroundtheworld.com Please include a recent picture of yourself for our records Date PERSONAL DETAILS Please Print Clearly Full Legal Name Last First Middle Address City St Zip Home Phone / / Work / / Cell / / Fax Date of Birth / / Adult Shirt Size: S M L XL XXL XXXL Any medical conditions KIDS should be aware of? Any building experience? (please explain) Passport # Expiration Date (All passports must be valid for 6 months past trip return date) Emergency contact names(s) & phone # If needed, please use a separate sheet to write addresses of family & friends for trip updates while you re away. We will keep them informed daily as news comes into our office from the site: How did you hear about this trip? 1

2 TRIP COST Land Package (Double Occupancy) $1,400 Land Package (Single Occupancy) $2,200 This amount does not include air fare. Please check which land package you prefer. The above amounts are approximate costs for the land packages and could change. The land package includes all lodging, some KIDS t- shirts, in-country transportation, breakfast, lunch & 3 dinners, team photo/picture book and Emergency Evacuation Insurance. * Do you have a roommate preference? (Double Occupancy Land Pkg. only) - Name * If you do not have a roommate you would like to stay with, we will provide one for you. If there is not one available, you may be required to pay for a single room. I will get my own airline travel. (You MUST make your travel arrangements around our arrival/departure schedules. Please call us for those details before you book your own flight.) I would like to travel with the team. Please purchase my airline tickets and bill my credit card. I would like to fly out of airport. I would like to travel different dates than the team. Please call me before you purchase my airline tickets. PAYMENT This form must include a $200 non-refundable deposit Credit Card: (please circle) Visa MasterCard Discover Am Express / / / Exp. Date CVV Code (Last 3 digits on back of card) SIGNATURE TODAY S DATE *I give Kids Around the World permission to charge my $200 down payment on my credit card now. (please initial) *I give Kids Around the World permission to charge my airline costs and other pre-paid costs when due. (please initial) *I give Kids Around the World permission to charge the remainder of the costs 1 month before the trip. (please initial) If you are uncomfortable mailing your credit card information, please call us within 48 hours of mailing this application to confirm your reservation with a credit card number. Your place on this trip is not guaranteed until we have your deposit. Please initial the above 3 (*) lines to give us permission to charge your credit card once you call. Even if you are raising support for this trip, we must still receive payment. Your deposit and other prepaid costs will be returned to you if all of your funds come in. Thank you for your understanding. (Please make checks payable to Kids Around the World) 2

3 RELEASE FORM I, in consideration of the benefits derived from my participation (PRINT NAME) in the project trip to administratively organized by Kids Around (TRIP LOCATION) the World (hereafter referred to as KIDS) on do hereby (TRIP DATES) release, acquit, and forever discharge KIDS, its employees, officers, directors and representatives from any and all manner of suits, actions, claims, demands, and liabilities either by me or any and all persons having interest in me, for any and all injuries, illnesses, losses or damages I might incur on or in any way relating to my participation in this trip, without limitation whether in the USA or in any foreign country. I recognize that the conditions in some of the places to which I travel are not of the same standard as the conditions to which I am accustomed, (i.e.; political environments and judicial systems). I further realize that there are certain health and detainment risks as well as other risks to me and my property, and I enter into participation in this trip with awareness of those risks. I understand that this document constitutes a full and complete waiver of all possible claims, including claims for negligence in personal injury or property damage, arising out of my participation in this trip. No provision of this document shall, in any way, limit my right to make claims against persons other than KIDS, its directors, officers, employee and representatives. Photographic Release. I grant and convey unto KIDS all rights, title and interest in any and all photographic images and video or audio recordings made by KIDS during my work on this project including, but not limited to, any royalties, proceeds or other benefits derived from such photographs or recordings. (SIGNATURE OF APPLICANT) (PRINT NAME) If participant is under 18 years of age, parent or guardian signature is required. (PARENT OR GUARDIAN SIGNATURE) WITNESS: (PRINTED NAME) (SIGNATURE) (Witness must be18 years old or older) 3

4 CONTRACT PAYMENT INFORMATION Your place on the team is secured when you send in this application along with your $200 nonrefundable deposit. This deposit counts toward the total cost of your trip. As soon as we receive your application and $200 deposit, we will book your flights. We will purchase your airline tickets on your behalf and charge your credit card or ask you to submit a check as a donation for the cost of the travel expenses and other pre-paid costs (i.e. in-country flights, visa fees, or any other pre-paid items). One month before the trip date, your credit card will be charged or we will ask you to submit another check for the remainder of the trip. We will call you prior to charging your credit card or let you know what the check amount should be. If you are asking friends and family to help with the cost of your trip please ask your supporters to write your name and which trip you are participating in on a separate sheet of paper and include it with their check. You can call us anytime to get an update on your account balance. We would be happy to give you the names of your supporters so you may thank them. Make sure, however, that they make their checks payable to Kids Around the World (not to you) so they are eligible to receive a tax deductible receipt. Please send me small support envelopes to include with my support letter to family & friends. Included in the total costs of your trip is Emergency Evacuation Insurance. AGREEMENT Thank you for your interest in helping make a difference in the lives of children. As you know, airfare has changed dramatically in recent years. You may not know that the IRS has also made changes in their guidelines for qualifying donations to not-for-profit organizations. All of these changes have brought about a need for organizations like Kids Around the World to make changes in certain areas too. By completing this contract, I agree to accept the terms set forth, in order to comply with the governmental effects new rules have on our operation. The most important change is the clarification that all monies received by organizations like Kids Around the World, are considered donations under IRS rules. We are prohibited in almost all situations from returning donations once they have been submitted. Regretfully, we must comply with these rules. (Continued on next pg.) 4

5 CONTRACT CONTINUED (AGREEMENT CONTINUED) By agreeing to this contract, I am indicating that I would like to participate on a playground build and/or ministry trip with Kids Around the World and I plan to either donate funds to cover my expenses for the trip, or raise donations accordingly. I realize that all checks should be made payable to Kids Around the World and sent to 2424 Charles St., Rockford, IL 61108, and that all monies will be earmarked at Kids Around the World for my expenses related to this trip. Kids Around the World may need to increase costs upon notice to participants. I understand that I am submitting a $200 non-refundable donation as a deposit for my participation. I will provide any pre-paid costs, (i.e. visa fees), along with any airline tickets for my travel purchased on my behalf by Kids Around the World. I will pay the remainder of the trip according to the terms specified on the application. In the event that I am unable to participate in this event, either because of my decision or because the trip is cancelled or postponed due to events beyond the control of Kids Around the World, I agree that any non-recoverable related costs Kids Around the World incurred on my behalf will be my responsibility. In the event the funds raised for my trip costs exceed my total costs, I agree to have those funds applied to the overall team costs for the trip in which the funds were originally intended. I also acknowledge and agree all funds received by Kids Around the World for this trip are considered tax-deductible donations, and are therefore subject to IRS regulations for such donations. I understand that in good faith Kids Around the World will attempt to help me schedule another trip in which I can apply my donated funds. But if rescheduling my trip is not feasible, all monies received on my behalf for this trip must be treated as a donation to Kids Around the World, and is therefore still eligible for consideration as a tax-deductible gift. (Signature) (Date) (If applicant is under 18 yrs. old signature of parent or guardian) (Date) 5

6 MEDICAL INSURANCE CONFIRMATION I am personally covered by the following medical insurance plan: (PRINT NAME) Insurance Company and Policy Number: This policy will be in effect while I participate in the Kids Around the World trip to: on the following dates:. (LOCATION OF TRIP) (DATES) (SIGNATURE OF APPLICANT) If participant is under 18 years of age, parent or guardian signature is required. (PARENT OR GUARDIAN SIGNATURE) 6

7 CHECKLIST Complete and return all pages of the Kids Around the World application form along with your $200 non-refundable deposit check (otherwise we will call you for your credit card information). For your reference, please make a copy of this application before mailing it to us. Passport (If you don t have one, please get one immediately!) Passport applications are available at major post offices. Please allow plenty of time and follow the instructions carefully. Passports are required only if you are going out of the country. If you do not yet have a passport, or if your passport has expired or will expire soon, a note saying that you have applied for or have sent your passport in for renewal will suffice. (Note: Due to the passport laws in some countries, passports MUST be valid for six months after the trip ends. If your passport is due to expire before the sixth month point after the trip, you will need to apply for a new one. We must have a clear, readable copy of your passport sent in along with your Application Form. Recommended immunizations for Kyrgyzstan according to are: - Hepatitis A - Typhoid - Hepatitis B - Rabies - Yellow Fever - Measles, mumps, rubella (MMR) 2 doses recommended for all travelers born after 1956, if not previously given. - Tetanus-diphtheria. Revaccination recommended every 10 years. PLEASE call your healthcare provider for their recommendations IMPORTANT DETAILS Diana Hamachek at dianah@kidsaroundtheworld.com with questions. Full schedule and itinerary of this trip will be available soon. 7