Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

MINOR RELEASE FORM ADULT RELEASE FORM PARENT CONSENT FORM by byrnetown75

VIEWS: 219 PAGES: 2

									                                  EXPEDITION PLANNING FORM (PG 2)
EXPEDITION CHECKLIST
PROJECTS
Deposit Amount
Types
    Release Form
                                   PARTICIPANT INFORMATION SHEET
                                  EXPEDITION PLANNING FORM (PG 1)
    Passport or Wulfenstein
I, Amanda IreneBirth Certificate & ID bring for 793 E. 550 S.
Date                   Sponsoring to , of
Equipment/items participants need Organization  projects                      [address],    Santaquin                 [City],
TO WHOM IT MAY CONCERN:
I, Richard Talbot Wulfenstein          , of     793 E. 550 S.                 [address],    Santaquin                 [City],
   Travel Date
Expedition Insurance                                    Expedition Location
       Utah        [state], hereby acknowledge that I have voluntarily applied to participate in an expedition to
                       August 19 - 27, 2008         I have voluntarily      Amanda Irene Wulfenstein
For Immunizations [state], hereby acknowledge thatthe following child:applied to participate in an expedition to
     the period of
       Utah
CONTACT INFORMATION
       Mexico                  [country].
PERSONAL INFORMATION Wulfenstein            MINOR CONSENT FORM Size (circle one) XXL XL L M S
                                            ADULT Address
                                [country]. PARENT RELEASE FORM
                                                                        T-shirt
is inPaid Full of
      the care         Richard Talbot                    .
NameMexico Amount (amount paid if different                                     )
Classes to be taught according to participants’ abilities and education
Name (First and Last)                                                   Birthday (dd/mm/yyyy)
I AM AWARE THAT THIS COUNTRY MAY BE POLITICALLY UNSTABLE AND THAT I MAY BE EXPOSED TO HAZARDS IN THE
                                                             State                            Zip Code
Citythe parent(s)on your passport) named child I give full authority to the above named person to care for our child.
As     (as it appears of the above
FORM OF DISEASE, INJURY AND INCONVENIENCE. I UNDERSTAND THAT I MAY NOT HAVE ACCESS TO ADEQUATE
That AWARE THAT NEVERTHELESS AM Hm POLITICALLY UNSTABLE AND ACTIVITY WITH EXPOSED need
E-mail                                         BE Phone                            Cell Phone
I AM authority includes their makingIMAYVOLUNTARILY PARTICIPATING IN THISTHAT I medical KNOWLEDGE OF THE
MEDICAL FACILITIES. THIS COUNTRY decisions about travel, accommodations, and MAY BE care as the TO
Phone Number                                     Email Address
                         FOR OF DISEASE, INJURY AND INCONVENIENCE. I UNDERSTAND THAT I MAY NOT HAVE
ASSIGNMENTS FORM EXPEDITION above named period of time while they are traveling with an expedition
HAZARDS INthem AND authority for the ACCEPT ANY AND ALL RISKS OF DELAY, INJURY OR DEATH.
DANGER give THE filled out and signed by State adult expedition participant.
arises. I
This form must be this HEREBY AGREE TO every minorexpedition participant. It must also be signed by the
Address INVOLVED
This formwith Family to MEDICAL FACILITIES. Expeditions.
            must                                                      participant under the age of 18 IN THIS
ACCESSparent or be filled out, signed and notarized for every AM VOLUNTARILY PARTICIPATINGthat is NOT
                                                                             City                      Zip
minor’s TO ADEQUATE Family Humanitarian NEVERTHELESS I
to Mexico
ACTIVITIES         legal guardian.
accompanied KNOWLEDGE OF THElegal guardians.
                    BOTH parents or DANGER INVOLVED AND
ACTIVITY WITHby being permitted by FAMILY concerns? IfHUMANITARIAN EXPEDITIONS toACCEPT ANY AND ALL I
Do you have any special dietary needs or health TO FAMILY yes, pleaseHEREBY AGREE TO participate in this activity,
As consideration DETAILS
EXPEDITION for                                                        explain
hereby OFday (fun INJURY distributes,
Discovery DELAY, my heirs,
RISKS agree that I,activity) OR DEATH.guardians, legal representatives and assigns will not make a claim against, sue,
attach the Expedition Date
Proposed property of or prosecute FAMILY TO FAMILY HUMANITARIAN EXPEDITIONS, its directors, officers, agents or
                                                      Desired Location (circle one) Querétaro       Veracruz
Location                                             Transportation                                  Cost
As consideration for being permitted by FAMILY TO FAMILY HUMANITARIAN EXPEDITIONS to participate in this
employees for injury or damage resulting from the negligence of other acts, howsoever caused, by any employee, agent or
INSTRUCTIONS
Estimated Number of TO that I, HUMANITARIAN EXPEDITIONS as result of my participation in this expedition. make a
activity, I hereby agreeFAMILYmy heirs, distributes, guardians,alegal representatives and assigns will notIn addition,
contractor of FAMILY Participants
INSTRUCTIONS
(Signature of                                                     (Signature of parent)
claim against,parent) the form and then or prosecute FAMILY TO FAMILYFamily Humanitarianagents and its
INSTRUCTIONSsign
Please release sue, attach the property of either mail or fax it EXPEDITIONS, its directors, officers, Expeditions.
I herebyfill out and discharge FAMILY TO FAMILY HUMANITARIAN to Family to HUMANITARIAN EXPEDITIONS,
                  and
EXPERIENCE all COMMUNITY demands, I, to mail
NEEDS officers, agents or employees for injury or or fax it to Family to Family Humanitarian Expeditions.
directors,OF THE sign theclaims or as then either you damage resulting fromlegal negligence of other acts,now have
Please fill out and actions, form and it applies my heirs, distributes, guardians, the representatives or assigns
employees, from Fill out information
Pleasehereafter haveby anynotarize the resultingcontractor of FAMILYlegal expedition.
or may fill that both and employee, form and then participation TOfax it
MAIL TO: ARRANGEMENTS damagecheck participant’s parent or or Sylia Natashia must sign.
Remember out, signfor Wulfenstein AND theor from my either mail in require)to Family to Family
TRAVEL caused, the participant
howsoeverRichard Talbotinjury or (Please agent all transportation means you thisguardian Wulfenstein
                                                                                    FAMILY HUMANITARIAN EXPEDITIONS
School/Major my Humanitarian Expeditions
Family to Family participation in this expedition. In addition, I hereby release and discharge FAMILY TO FAMILY
as a result of of parent)
Humanitarian Expeditions.
(Printed name                                                     (Printed name of parent)
4219 TO:
MAILNorth Canyon Road
     Flights
HUMANITARIAN EXPEDITIONS, its directors, officers, agents and employees, fromAM actions,THAT THIS IS A
I HAVE CAREFULLYHumanitarian Expeditions
Provo, to Family READ THIS                   AND specify UNDERSTAND ITS CONTENTS. I all AWARE claims or
HOUSING ASSIGNMENTAGREEMENT (PleaseFULLY departure and arrival locations)
Family Utah 84604
Mission                                                               Foreign Language
               my heirs, distributes, guardians, legal representatives or assigns now have or may EXPEDITIONS, AND
demands, I, LIABILITY AND A CONTRACT BETWEEN MYSELF AND FAMILY TO FAMILY HUMANITARIAN hereafter have for
MAILNorth Canyon Road
4219 TO:OF
RELEASE
     Bus
STATE OF
DonationsLived IT OF MY OWN FREE WILL. ) (Please specify this expedition.
FAX TO: Family resulting
FamilySIGNED in Humanitarian Expeditions
Provo, to to 84604
Countries
                                             COUNTY
injury or damageor Visited from my participation in departure and arrival locations)
I HAVE Utah be gathered
                                                                                          )
Residence
4219 North Canyon Road
(801) 796-7631 instrument was acknowledged before me,
The Car Rental
     foregoing                                                                                 , a Notary Public in the
Provo, CAREFULLY
I HAVE Utah 84604 READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT
FAX TO: been on a past expedition? If so, when/where? departure and arrival locations)
Have you
Participant Roommate                         (Please specify

(801) 796-7631 PAYMENT
County                                  , CONTRACT BETWEEN MYSELF AND FAMILY TO FAMILY
THIS IS of RELEASE OF LIABILITY AND A State of                         .
Dated: A
COSTS AND
FAX TO:                                      Signed:
Current Employer EXPEDITIONS, AND I HAVE SIGNED IT OF MY OWN FREE WILL.
HUMANITARIAN
ACCOMMODATIONS (Please circle desired option)
(801) 796-7631
Witness of signature and official seal this
Total CostmyExpedition Per Participant               day of               , 2007.
Homes        Government
My commission expires: Sponsored Facilities
Payment Schedule
                                            Hotels
                                             Due OF MINOR
AGREEMENT AND CONSENT OF PARENT OR GUARDIAN date                                                Cost
TALENTS
Deposit ($150 guardian of the above
I, as parent or Non-Refundable) $250 applicant, agree individually and on behalf of my child or ward, to the terms of the above
Please list your talents, skill, hobbies
MEALS (NOTE: 2Imeals will be provided per day (except travel days) of my child or ward while on this expedition.
release of liability. represent that I will be solely responsible for the care
Balance due (Non-Refundable) indemnify and hold harmless FAMILY TO FAMILY HUMANITARIAN EXPEDITIONS its directors,
Furthermore, I hereby agree to
Dated: ofAugust 16, 2008
Location meals                                         Signed: (60 days prior to departure date)
officers, agents and employees from any loss, liability, damage or cost they might incur due to the presence of my child or
ward on this expedition.
Additional meals requested

Dates list talents
Pleaseand times you would be interested in sharing
                                                                                      Notary Public
Dated:                                             Signed:
Locations

                                                                                  Additional Cost



    4219 north canyon road, provo, ut 84604                     [   tel ] 801.372.1087      [   fax ] 801.796.7631
                                  EXPEDITION PLANNING FORM (PG 2)
EXPEDITION CHECKLIST
PROJECTS
Deposit Amount
Types
    Release Form
                                   PARTICIPANT INFORMATION SHEET
                                  EXPEDITION PLANNING FORM (PG 1)
    Passport or Wulfenstein
I, Amanda IreneBirth Certificate & ID bring for 793 E. 550 S.
Date                   Sponsoring to , of
Equipment/items participants need Organization  projects                      [address],    Santaquin                 [City],
TO WHOM IT MAY CONCERN:
I, Richard Talbot Wulfenstein          , of     793 E. 550 S.                 [address],    Santaquin                 [City],
   Travel Date
Expedition Insurance                                    Expedition Location
       Utah        [state], hereby acknowledge that I have voluntarily applied to participate in an expedition to
                       August 19 - 27, 2008         I have voluntarily      Amanda Irene Wulfenstein
For Immunizations [state], hereby acknowledge thatthe following child:applied to participate in an expedition to
     the period of
       Utah
CONTACT INFORMATION
       Mexico                  [country].
PERSONAL INFORMATION Wulfenstein            MINOR CONSENT FORM Size (circle one) XXL XL L M S
                                            ADULT Address
                                [country]. PARENT RELEASE FORM
                                                                        T-shirt
is inPaid Full of
      the care         Richard Talbot                    .
NameMexico Amount (amount paid if different                                     )
Classes to be taught according to participants’ abilities and education
Name (First and Last)                                                   Birthday (dd/mm/yyyy)
I AM AWARE THAT THIS COUNTRY MAY BE POLITICALLY UNSTABLE AND THAT I MAY BE EXPOSED TO HAZARDS IN THE
                                                             State                            Zip Code
Citythe parent(s)on your passport) named child I give full authority to the above named person to care for our child.
As     (as it appears of the above
FORM OF DISEASE, INJURY AND INCONVENIENCE. I UNDERSTAND THAT I MAY NOT HAVE ACCESS TO ADEQUATE
That AWARE THAT NEVERTHELESS AM Hm POLITICALLY UNSTABLE AND ACTIVITY WITH EXPOSED need
E-mail                                         BE Phone                            Cell Phone
I AM authority includes their makingIMAYVOLUNTARILY PARTICIPATING IN THISTHAT I medical KNOWLEDGE OF THE
MEDICAL FACILITIES. THIS COUNTRY decisions about travel, accommodations, and MAY BE care as the TO
Phone Number             FOR OF DISEASE,Email Address INCONVENIENCE. I UNDERSTAND THAT I MAY NOT HAVE
ASSIGNMENTS FORM EXPEDITION above named period of time while they are traveling with an expedition
HAZARDS INthem AND authority for the ACCEPT ANY AND ALL RISKS OF DELAY, INJURY OR DEATH.
                                           INJURY AND
DANGER give THE filled out and signed by State adult expedition participant.
arises. I
This form must be this HEREBY AGREE TO every minorexpedition participant. It must also be signed by the
Address INVOLVED
This formwith Family to MEDICAL FACILITIES. Expeditions.
            must                                                      participant under the age of 18 IN THIS
ACCESSparent or be filled out, signed and notarized for every AM VOLUNTARILY PARTICIPATINGthat is NOT
                                                                             City                      Zip
minor’s TO ADEQUATE Family Humanitarian NEVERTHELESS I
to Mexico
ACTIVITIES         legal guardian.
accompanied KNOWLEDGE OF THElegal guardians.
                    BOTH parents or DANGER INVOLVED AND
ACTIVITY WITHby being permitted by FAMILY concerns? IfHUMANITARIAN EXPEDITIONS toACCEPT ANY AND ALL I
Do you have any special dietary needs or health TO FAMILY yes, pleaseHEREBY AGREE TO participate in this activity,
As consideration DETAILS
EXPEDITION for                                                        explain
Discovery DELAY, my heirs,
hereby OFday (fun INJURY distributes,
RISKS agree that I,activity) OR DEATH.guardians, legal representatives and assigns will not make a claim against, sue,
attach the Expedition Date
Proposed property of or prosecute FAMILY TO FAMILY HUMANITARIAN EXPEDITIONS, its directors, officers, agents or
                                                      Desired Location (circle one) Querétaro       Veracruz
Location                                           Transportation                                    Cost
As consideration for being permitted by FAMILY TO FAMILY HUMANITARIAN EXPEDITIONS to participate in this
employees for injury or damage resulting from the negligence of other acts, howsoever caused, by any employee, agent or
INSTRUCTIONS
Estimated Number of TO that I, HUMANITARIAN EXPEDITIONS as result of my participation in this expedition. make a
activity, I hereby agreeFAMILYmy heirs, distributes, guardians,alegal representatives and assigns will notIn addition,
contractor of FAMILY Participants
INSTRUCTIONS
(Signature of                                                    (Signature of parent)
claim against,parent) the form and then or prosecute FAMILY TO FAMILYFamily Humanitarianagents and its
INSTRUCTIONSsign
Please release sue, attach the property of either mail or fax it EXPEDITIONS, its directors, officers, Expeditions.
I herebyfill out and discharge FAMILY TO FAMILY HUMANITARIAN to Family to HUMANITARIAN EXPEDITIONS,
                  and
NEEDS officers, agents or employees for injury or or fax it to Family to Family Humanitarian Expeditions.
EXPERIENCE all COMMUNITY demands, I, to mail
directors,OF THE sign theclaims or as then either you damage resulting fromlegal negligence of other acts,now have
Please fill out and actions, form and it applies my heirs, distributes, guardians, the representatives or assigns
employees, from Fill out information
Pleasehereafter haveby anynotarize the resultingcontractor of FAMILYlegal expedition.
or may fill that both and employee, form and then participation TOfax it
MAIL TO: ARRANGEMENTS damagecheck participant’s parent or or Sylia Natashia must sign.
Remember out, signfor Wulfenstein AND theor from my either mail in require)to Family to Family
TRAVEL caused, the participant
howsoeverRichard Talbotinjury or (Please agent all transportation means you thisguardian Wulfenstein
                                                                               FAMILY HUMANITARIAN EXPEDITIONS
School/Major my Humanitarian Expeditions
Family to Family participation in this expedition. In addition, I hereby release and discharge FAMILY TO FAMILY
as a result of of parent)
Humanitarian Expeditions.
(Printed name                                                    (Printed name of parent)
4219 TO:
MAILNorth Canyon Road
     Flights                                                                              all AWARE claims or
HUMANITARIAN EXPEDITIONS, its directors, officers, agents and employees, fromAM actions,THAT THIS IS A
HOUSING ASSIGNMENTAGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I
Provo, to Family READ THIS
I HAVE CAREFULLYHumanitarian Expeditions
Family Utah 84604
Mission                                                              Foreign Language
               my heirs, distributes, guardians, legal representatives or assigns now have or may EXPEDITIONS, AND
demands, I, LIABILITY AND A CONTRACT BETWEEN MYSELF AND FAMILY TO FAMILY HUMANITARIAN hereafter have for
MAILNorth Canyon Road
4219 TO:OF
RELEASE
     Bus
STATE OFto be gathered
DonationsLived IT OF MY OWN FREE WILL. ) COUNTY
FamilySIGNED in Humanitarian Expeditions
         to Family resulting
injury or damageor Visited from my participation in this expedition.
Provo,
I HAVE Utah 84604
FAX TO:
Countries
                                                                                       )
Residence
4219 North Canyon Road
(801) 796-7631 instrument was acknowledged before me,
The Car Rental
     foregoing                                                                                 , a Notary Public in the
Provo, CAREFULLY
I HAVE Utah 84604 READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT
FAX TO: been on a past expedition? If so, when/where?
Have you
Participant Roommate
(801) 796-7631 PAYMENT
County                                  , CONTRACT BETWEEN MYSELF AND FAMILY TO FAMILY
THIS IS of RELEASE OF LIABILITY AND A State of                         .
Dated: A
COSTS AND
FAX TO:                                      Signed:
Current Employer EXPEDITIONS, AND I HAVE SIGNED IT OF MY OWN FREE WILL.
HUMANITARIAN
ACCOMMODATIONS (Please circle desired option)
(801) 796-7631
Witness of signature and official seal this
Total CostmyExpedition Per Participant               day of               , 2007.
Homes        Government
My commission expires: Sponsored Facilities
Payment Schedule
                                            Hotels
                                             Due OF MINOR
AGREEMENT AND CONSENT OF PARENT OR GUARDIAN date                                                Cost
TALENTS
Deposit ($150 guardian of the above
I, as parent or Non-Refundable) $250 applicant, agree individually and on behalf of my child or ward, to the terms of the above
Please list your talents, skill, hobbies
MEALS (NOTE: 2Imeals will be provided per day (except travel days) of my child or ward while on this expedition.
release of liability. represent that I will be solely responsible for the care
Balance due (Non-Refundable) indemnify and hold harmless FAMILY TO FAMILY HUMANITARIAN EXPEDITIONS its directors,
Furthermore, I hereby agree to
Dated: ofAugust 16, 2008
Location meals                                         Signed: (60 days prior to departure date)
officers, agents and employees from any loss, liability, damage or cost they might incur due to the presence of my child or
ward on this expedition.
Additional meals requested

Dates list talents
Pleaseand times you would be interested in sharing
                                                                                      Notary Public
Dated:                                             Signed:
Locations

Additional Cost



    4219 north canyon road, provo, ut 84604                     [   tel ] 801.372.1087      [   fax ] 801.796.7631

								
To top