AFFIDAVIT-AUTHORIZATION FOR MINOR TO TRAVEL by zhouwenjuan

VIEWS: 10 PAGES: 9

									                                                                            TO EMAIL APPLICATION:
                                                                            1. Go to “File”
                                                                            2. Go to “Send to”
                                                                            3. Go to “Mail Recipient (as Attachment)
                                                   TEAM




                                                                            4. Email to info@mvi.org



           SHORT-TERM MISSION APPLICATION

READ THIS CAREFULLY
Everyone must fill out a complete Missionary Ventures International (MVI) application once
every 2 years. Each time you travel you must submit:

          1. A signed Release of Liability
          2. A completed Skills & Experience form
          3. A Copy of the information page of your passport
          4. A Emergency Contact Sheet
          5. Must answer all questions pertaining to medical history

I. PASSPORT COPY

       We must have a photocopy of the information page of your passport, as well as be able to
        see the face clearly. Please DO NOT FAX a copy of your passport. The faxed copy is not
        legible and the picture is too dark to read.
       It must be valid for at least 6 months after your expected return date.
       Due to heightened security measures, your name on your airline ticket must read
        EXACTLY as it appears on your PASSPORT.

       In the event your passport has not been submitted to MVI at the time of ticketing, and your
        name is submitted to MVI incorrectly, you will be responsible for a penalty of $150
        (subject to change) to change your name, otherwise you may be denied boarding by the
        airlines upon check-in at the airport.

II. RELEASE OF LIABILITY
   EVERYONE must sign a Release of Liability before departing on every mission trip
   sponsored by MVI.
III. AIRLINE TICKETS
      All plane tickets must be issued as a team and at the same time.
    Frequent Flyer Tickets
     Team member cannot use frequent flyer tickets. They can prevent the team from receiving
     group airfare rates.
        Frequent flyer numbers must be given at time of check-in at the airport.
    Extended Stays
     Any team member, who would like to extend their stay in-country, will only be allowed to
     change their return flight until AFTER they have arrived in-country. This must be done
     directly with the airlines only if time permits. Penalty fees apply.

If you have any questions regarding our application or procedures, please feel free to contact the
Team Trip Department at 407-859-7322.

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                                                                                        revised 11/21/12
                  SHORT-TERM MISSION APPLICATION
• Please type or print neatly.
• Please scan a copy of the INFORMATION PAGE of your PASSPORT and email to info@mvi.org .
• Your non-refundable application fee and deposit is required with your application.

Country for which applying:                                   Trip date:            (MM/DD/YYYY)
Are you a US citizen?       Yes   No       If not, what is your citizenship?
Do you have a current passport?      Yes       No
Passport Number:                                              Expiration Date:               (MM/DD/YYYY)
Passport Name:       Mr.      Mrs.      Miss        Ms.
LAST:                                FIRST:                       MIDDLE:

ADDRESS:
CITY:                                   STATE:                          ZIP:
HOME PHONE:                                                   WORK PHONE:
CELL PHONE:                                                   FAX NUMBER:
EMAIL:
                                                              TSHIRT SIZE:              S    M       L
DATE OF BIRTH:              (MM/DD/YYYY)
                                                                                        1X    2X         3X
Marital Status:    Single     Married       Divorced        Separated      Widowed           Other
Next of Kin:
LAST:                                FIRST:                       MIDDLE:
ADDRESS:                                                          PHONE:
    IT IS IMPORTANT THAT YOU ANSWER THE NEXT (3) QUESTIONS COMPLETELY
DO YOU HAVE ANY PHYSCIAL LIMITATIONS?                       Yes      No
Please explain:
DO YOU HAVE ANY MEDICAL CONDITIONS THAT REQUIRED MEDICATIONS?                                        Yes      No
Please List and included medications? (Physical, Emotional, Mental):


DO YOU HAVE ANY ALLERGIES? (Food or Other)                     Yes        No
Please List:
Home Church Name:
Pastor’s Name:
Address:                                            City:                      State:            Zip:

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                          TELL US ABOUT YOURSELF
                                Use additional paper if necessary

1. Are you a Christian?     Yes     No


2. How long have you been a believer?




3. What does salvation mean to you?



4. Briefly describe your relationship with Christs.




5. Have you had formal witnessing training and if so what kind?




6. What is your view of marriage from a Biblical perspective?




7. What is your view of homosexuality from a Biblical perspective?




8. Why do you want to be a part of a mission team?




9. What are your strengths/weaknesses?




10. How do you see your strengths/weaknesses as being a help/hindrance while on the field?




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                                  TEAM MEMBER
                              SKILLS AND EXPERIENCE

Have you been on a Missions Trip before?       Yes     No
When & Where?
Type of team?
Which Organization?
Are you willing to participate in a 5-10 minute devotion during your trip?    Yes      No
Do you speak any other languages?      Yes     No
What language(s)?                             Are you fluent?       Yes      No
       PLEASE CHECK OFF AREAS WHERE YOU HAVE SKILLS OR EXPERIENCE IN
ADMINISTRATION                 MINISTRY SKILLS                                      CONSTRUCTION
  Management                     Dramatic presentation                                Concrete work
  Office/Clerical                Proclamation/Teaching                                Masonry
  Human Resources                Pastoral Care                                        General Construction
  Purchasing                     Counseling                                           Electrician
  Inventory Control              Worship/Music Ministry                               Plumber
  Transport/Shipping             Men’s Ministry                                       Mechanic
  Logistics                      Women’s Ministry                                     Well Drilling
                                 Children’s Ministry                                  Cabinetmaker
COMMUNICATIONS                   Youth Ministry                                       Grounds Maintenance
  Photography                    Other                                                Waste Water Management
  Video Productions                                                                   Welding
  Press Relations              EDUCATION                                              Property Management
  Graphic Arts/Designing         School Teacher                                       Steel Repair
  Videography                    School Principal
  Print Production               Pre-School/Nursery Teacher                         TECHNICAL/ENGINEERING
  Website Development            Home Schooling                                       Computer Programmer
  Public Relations               Nanny                                                Computer Technician
  Sound Technician                                                                    Electronics Technician
  Recruitment                  HEALTH CARE                                            Telephone Technician
  Marketing                      Physician/specialty:_____________________            Systems Design
  Fundraising                     Surgeon/specialty: _____________________            Network Skills
  Journalism
                                  Nursing/specialty: _____________________          AGRICULTURAL & SERVICE
FINANCES                          Anesthesia                                        INDUSTRY
   Controller                     Pharmacology                                         Farming
   Accounting                     Public Health                                        Animal Husbandry
   Bookkeeping                    Dental/specialty: ______________________             Horticulture
   Data Entry                     Optometry                                            Sales
   Other                          Laboratory                                           Housekeeper
                                  X-Ray Technician                                     Catering/Food Preparation
                                  Physical/Occupational Therapist                      Other
                                  Other

NOTE: If you are under the age of 18, you must obtain a copy of the “PARENT/GUARDIAN
      TRANSFER OF RESPONSIBILITY” form and have it signed by your parents and a Notary
      Public. Release of Liability/Team Member Commitment Form is signed and attached.

APPLICANT’S SIGNATURE
                                                            DATE          (MM/DD/YY)
PARENT'S SIGNATURE (if under 18)



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                                                                                              revised 11/21/12
AUTHORIZATION FOR MINOR TO TRAVEL


Dear Parents or Guardians,

For any minor under the age of 18 traveling with your team out of the
United States without Both Parents or a Legal Guardians, or traveling with
someone other than their Legal Parent(s) or Guardian(s), a notarized
affidavit, signed by a Parent(s) or Legal Guardian(s), must be obtained.
Someone traveling on this team must be appointed as a temporary guardian
of your child.

Please complete and sign before a Notary Public an Authorization for
Minor to Travel Affidavit . Please send a copy to Missionary Ventures
with your child’s application. Your child, must carry the Notarized
affidavit with them at all time. Your team leader will also have a copy of
this document.

Flying on Airlines as a Unaccompanied Minors

For any child under the age of 16 years of age, flying alone, you must
contact the airlines; request and pay for assistance for an unaccompanied
minor. This will required you to arrive at the airport at least 3 hours in
advance for international travel.

Note: You will not be able to do this until plane tickets have been issued for
      your team.

Please check with the Team Trip department before contacting the airlines.

If you should have any questions, please contact the Team Trip Department
at 407-859-7233.




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                                                                   revised 11/21/12
         AFFIDAVIT-AUTHORIZATION FOR MINOR TO TRAVEL

Parent or Guardian One:

I, (First, Middle, Last Name) __________________ of the city of ____________, state of
________________, hereby authorize my minor child,                           , age    , born on the
__ day of ____, 20       , to travel out of the United States to the country of                from
(date)              to (date)               under the custody of (First, Middle, Last Name)
___________________________________. Signed: _____________________________.
                                                                     (Temporary Custodian)

Parent or Guardian Two:

I, (First, Middle, Last Name) __________________ of the city of ____________, state of
________________, hereby authorize my minor child,                            , age   , born on the
__   day of           , 20           , to travel out of the United States to the country of _____
from (date)                     to (date)                 under the custody of (First, Middle, Last
Name)_______________________________.Signed: ____________________________.

As the lawful parent(s)or guardian(s) of          ____________          , we further authorize
the said Custodian(s) to render or cause to be rendered such emergency medical care to the
child as may be necessary or desirable for the purpose of the child’s well being on this trip.

We further understand that this temporary “delegation” of our parental powers, does not
relieve us of the primary responsibility of our child.

IN WITNESS WHEREOF, we have signed this Delegation of Custody, on this the ______
day of __________, 200___.
                               _______________________________
                                  Signature of guardian or parent (1)

                                                _______________________________
                                                  Signature of parent or guardian (2)
STATE OF ____________ )

____________COUNTY               )

          Sworn to and subscribed before me this the _____ day of __________, 200___.

                                          ________________________________
                                            NOTARY PUBLIC
Notary Seal My commission Expires: __________



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          MEDICAL CARE INFORMATION FOR MINORS

Team Member:_______________________Birthdate:_________ Age: ________
Parents: Mother: _____________________ Father: _______________________
Address: _________________________________________________________
Home Phone: ________________________Work :________________________
Email: ___________________________________________________________

EMERGENCY TELEPHONE NUMBERS:
1. Name:__________________________________Phone:_________________

  Address:_______________________________________________________

2. Name:__________________________________Phone:_________________

  Address:_______________________________________________________

MEDICAL INSURANCE INFORMATION:
Provider:_________________________________________________________

Provider’s address:_________________________________________________

Sponsor: ___________________________Policy Number: _________________

MEDICAL INFORMATION:

Special Conditions: ________________________________________________

Medications presently taking:

Drug: _________________________Dosage: _            Times: __________

Drug: _________________________Dosage:____________Times:__________

Allergies:________________________________________________________

SPECIAL INSTRUCTIONS:_________________________________
_______________________________________________________




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                                                            revised 11/21/12
                            EMERGENCY CONTACT
Team Member Name:                                     Passport #:
Current Address:                                      Phone:
City:       State:          Zip code:


E-Mail Address:                                       Date of Birth:   (MM/DD/YYYY)
T-Shirt size:      S    M       L       1X   2X          3X

MEDICAL CONDITIONS:

List Medications:

List Allergies:



         IN CASE OF EMERGENCY PLEASE CONTACT

PRIMARY CONTACT:
Name:           Relationship:
Address:
City/State/Zip code:
Phone:



SECONDARY CONTACT:
Name:           Relationship:
Address:
City/State/Zip code:
Phone:




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                                                                              revised 11/21/12
                              MISSIONARY VENTURES
               Release of Liability to MVI and Responsibility of Traveler
Missionary Ventures International, its Board, agents, servants, and employees, hereinafter “MVI”, acts
only as an agent for the Traveler in connection with all aspects of the Traveler’s

tour to:         commencing on the               day of          , 20   .

It is understood and agreed that MVI assumes no liability for injury, damage, loss, accident, medical
expenses, delay or irregularity which may be occasioned for any reason whatsoever, due to its own acts
or omissions or through the acts or omissions of any company or person engaged by MVI for the
purpose of, transporting or housing Traveler, or in carrying out the arrangements of the tour, and MVI
accepts no liability or responsibility for losses or additional expenses due to delay or changes in air or
other services, sickness, weather, strike, war, quarantine, or other causes. The right is reserved to MVI to
substitute living accommodations of similar quality to those specified in the itinerary and to cancel any
tour prior to departure, in which latter case a full refund will constitute full settlement to Traveler. No
refund will be made for any unused portion of the tour unless arrangements are made prior to departure
from the United States.
As a Christian organization our witness is very important. The use of illegal drugs, alcohol, or
tobacco products is strictly prohibited throughout the trip. No form of abuse and/or sexual
harassment of any kind will be tolerated. Appropriate action will be taken in every situation.
MVI reserves the right to send any team member home at their own expense, if there is an infraction
of the rules or if deemed necessary by the MVI’s Field Coordinator in order to protect the safety,
witness and work of the ministry within the country. You will be responsible for any costs incurred by
your actions. Thank you for your courtesy and cooperation with MVI’s rules and the local customs of
the country.
TRAVEL INSURANCE WAIVER
MVI is a non-profit 501 (C) (3) organization and all funds received are tax deductable and
non-refundable. Therefore, we highly recommend that you purchase a comprehensive trip cancellation
insurance policy through a vendor of your choice. MVI only provides an emergency medical insurance
policy valid outside the United States.
I have elected to purchase a more comprehensive travel insurance policy.

I have decided not to purchase a more comprehensive travel insurance policy
and accept the emergency medical insurance policy provided by MVI.
I/we have read the foregoing and understand that it is a full and complete release of liability of MVI.
Note: If you are under the age of 18, a Parent or Legal Guardian must sign this.

______________________________________________________________          DATE: ________________
                           TRAVELER
THE UNDERSIGNED are the legal parents or guardian of the Traveler referred to above, and agree(s)
to the foregoing RELEASE OF LIABILITY AND RESPONSIBILITY OF TRAVELER.

______________________________________________                              DATE: _________________
             PARENT or GUARDIAN           9
                                                                                         revised 11/21/12

								
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