TRAVEL RELEASE FORMS

TRAVEL RELEASE AND ACCEPTANCE PACKET FORMS

Important Information and Instructions:

These forms are not needed for your acceptance, but are required for you to travel with Big World Ventures. Please mail your original, notarized travel release forms to us as soon as possible. Do not email or fax them to us, they must be originals.

Consent for Medical Treatment—

Release and Hold-Harmless for Travel

(This form must be notarized)

Name: _____________________________________________

WHEREAS, (my child/I) _______________________________,

wishes to be a member of the missions program organized by Big World Ventures which will be traveling and staying in the U.S. and to and in other countries, and WHEREAS, certain circumstances and situations may occur resulting in (my child’s/my) need for medical/dental care and treatment, and further resulting in my inability to personally give consent for such care and treatment; THEREFORE,

1. In consideration of permission for (my child/myself) to participate in said mission, I

__________________________, being of legal age, authorize any agent of Big World Ventures, Inc., to act in (my child’s/my) behalf should I/they be unable to do so and to consent to reasonable medical/dental care and treatment, including but not limited to diagnostic test, x-ray examination, anesthesia, surgery or other procedures which may be deemed necessary for (my child’s/my) medical well-being for the duration of the mission.

2. This consent is given in advance of any specific diagnosis, treatment, surgery or hospital

care required, but is given to provide authorization and specific consent for medical/dental treatment and care in (my child’s/my) behalf.

3. Any consent by Big World Ventures, Inc., shall have the same force and effect as if I had personally given the consent.

4. I am aware that serious illness, requiring return by air ambulance could cost more than $10,000. I agree that I am solely responsible for any expenses that may arise from (my child’s/my) return by air ambulance or other extraordinary means.

5. I hereby release and hold harmless Big World Ventures, its officers, employees and representatives/volunteers from all liability for personal injury, including death, as well as all property damage or loss arising out of (my child’s/my) participation in the missions program.

(If you are under custody of both parents, we need both parents’ signatures. If you are not, we need the signature of the one who has custody of you. Some foreign countries require this.)

Certain Limitations

Name (Please Print) _____________________________

In the event of any crisis - political, natural, or missions related, any political unrest or natural disaster, Big World Ventures decides if and where to send individuals in the Missions and/or Internship Program.

Big World Ventures is a disciplined organization with regulations in certain areas, including conduct, dress, and Christian life-style. These are explained in the acceptance packet sent to the accepted applicant. All individuals participating in the Missions and/or Internship Program will adhere strictly to Big World Ventures’ policies and are subject to dismissal for disobedience, without refund or reimbursement. All individuals in the Missions and/or Internship Program serve at their own risk and Big World Ventures is not liable in the event of sickness, accident, death, or terrorist acts, or for transportation or any other expenses beyond that of normal involvement. I also give Big World Ventures permission to use my picture, voice and/or testimony in any type of promotional advertisement.

BWV Honor Agreement

Before signing this agreement, please review all BWV rules and regulations in the Travel Guide at www.bigworld.org/travelguide.htm .

The rules and regulations of Big World Ventures are designed to insure the safety and well being of each individual. These guidelines help to maintain the high standard of Christian integrity required to minister in the States, as well as, in cross-cultural settings. I understand the rules, regulations and conduct of the Big World Ventures Summer Missions and/or Internship Program and agree to adhere to any of the Big World Ventures’ staff or leadership may require of me. Enforcement shall occur in a manner that they feel is in accordance with Christian principles and the stated purpose of the project.

I will submit and cooperate with the leadership established by Big World Ventures. I understand that BWV expects full cooperation from members and parents in disciplinary decisions made. I understand that BWV reserves the right to send any individual home who shows disregard for the stated rules and regulations. I am also aware that the individual and/or his or her family are responsible for any cost involved in sending the team member home.

My/Our enclosed signature signifies my approval of all limitations listed above. My/Our signature represents that all the information on the forms is true and correct to the best of my/our knowledge.

Applicant/ Participant signature: ____________________________ Date:_________

Parent(s) or Legal Guardian(s) signature: ______________________ Date:__________

(if applicant is under 18 years of age)

Parent(s) or Legal Guardian(s) signature: ______________________ Date:__________

(if applicant is under 18 years of age)

Please have this form notarized.

State of ___________________.

County of _________________.

Before me, the undersigned, a Notary Public in and aforesaid County and State of ________, ___________, 20__, personally appeared the identical person who executed the within and

forgoing instrument, and acknowledged to me that he/she executed the same as his/her free and voluntary act and deed, for the uses and purposes therein set forth. Given under my hand and seal of office the day and year above written.

__________________________________

My commission expires: _________________

Notary Public Stamp

Health Insurance Policy Form

As a participant in the missions and/or internship program, we require that you have personal health insurance that covers you out of the country from the first to the last day of your venture. List your health insurance company name and policy number below. If your present insurance company does not cover you in other countries, you will be required to get a temporary insurance that covers you out of the country for the duration of your venture with Big World Ventures. Out of the country health insurance is mandatory. Below are some suggested temporary, out of the country health insurance agencies, that you may want to contact. Choose the best plan that fits your individual needs.

Name of Insured: ___________________________________

Dependant’s Name: _________________________________

Name of health insurance company:______________________

Policy #: ________________ I.D.#_____________________

Does this company cover you while out of the country? __ yes __ no

Domestic and international medical insurance coverage is MANDATORY. If you don’t have insurance, you can call any of the following:

Travel Protectors 1-703-443-9055 or info@travelprotectors.com / http://www.travelprotectors.com/ and click on the Big World Ventures logo (Recommended)

Travel Guard International 1-800-826-1300

Globalcare Travel Insurance 1-800-821-2488

Travel Insured International 1-800-243-3174

EMERGENCY CONTACT NUMBERS

Full Name of Participant

Parents/Legal Guardians (First and Last Names)

( ) ( )

Home Phone Number Parent’s Cell Phone Number

______________________________________________________________________________

Parent’s Email Address

If your parents do not have a cell number that you can include as your second emergency contact number, please fill out the remaining information with someone else we can call in case of an emergency, and include their relationship with you.

2^nd Contact’s Full Name

Relationship to Trip Participant

( ) ( )

Phone Number 2^nd Phone Number

______________________________________________________________________________

Contact Email Address

PASSPORT NUMBER AND PHOTOGRAPH

Legal Name: _____________________________

Passport Number: _________________________

PLEASE ATTACH A PHOTOCOPY OF YOUR PASSPORT TO THIS SHEET, BUT ALSO PLEASE REMEMBER TO BRING YOUR PASSPORT WITH YOU IN ORDER TO TRAVEL.

Travel Agreement

I will be arriving by 3:00 pm on the first day of training in Miami. You have been provided with specific arrival instructions in your acceptance packet, if you have any questions before booking your travel, please contact our staff. The following is my transportation information:

Type of transportations: Car Plane Other

Date of Arrival: ________________________

Scheduled Arrival Time: __________________

Arrival Location: Hotel Airport

Arrival Airline and Flight Number: _________________________

Last City Coming From: _________________

At the end of the trip:

Date of Departure: ______________________

Departure Location: _____________________

Scheduled Departure Time: ________________

Name of Airline: _______________________

Departure Flight Number: _______________

Printed Name of Applicant: _______________________________

Signature of Applicant: ________________________ Date: ______

Signature of Parent: ___________________________ Date: ______

(if applicant is under age 18)

Please return to:

Big World Ventures

PO Box 703203

Tulsa, OK 74170-3203

Contribution form_________________________________________________

According to IRS policy, tax deduction for contributions may only be given if the donor does not specify how the funds are to be used. This contribution form is provided to keep records of your donors. Please record every donation a form and send one into BWV with your checks.

Please make copies of this form and send one with each payment

SUMMER VENTURE AND/OR INTERNSHIP PAYMENT CONTRIBUTION FORM

Name: _____________________________________________________Date:_______________

Address: ______________________________________________Phone: (____) _____________

City: _____________________________________________ State: _______ Zip: ____________

Donor Name Address Check # Amount

Total Number of Checks Enclosed: _______ Total Amount Enclosed: _________