STRIPE - Short-Term Team Application Packet

General Information
IMPORTANT: The following passport name entered will be used to purchase your plane ticket. The name on your passport at time of travel MUST match the name on your plane ticket. The airline will not give you a boarding pass if there are any discrepancies.
Legal (Passport) Name*

First NameMiddle NameLast Name
Is this your legal name that will be used at time of travel?*

Yes, this is correctNo, it will change
What is your passport expiration date?*

MonthDayYear
Will your passport expire within the next 6 months?*

Yes, it will expireNo, it will be valid
Date of Birth*

MonthDayYear
Gender
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Marital Status
Present Occupation
Title; Company/Organization; Phone
For Students
Name of College
Declared Degree/Major
Expected Graduation Year

Medical Information

Medical information will be shared with the team leader and necessary CRI staff only. This information is needed to purchase short-term team medical evacuation insurance for the trip.
Check all that apply:*

GlassesContactsDenturesHearing AidsProsthesisNoneOther
Describe any significant illness, injury or surgery in the past year.
Do you have any pre-existing conditions? If yes, what are they?
List Rx and non-Rx medications that will/may be taken during the trip.
If applicable, do you know what malaria prescription you plan to take?
Do you have any known medication allergies?
Do you have any food allergies or dietary restrictions? Please explain.
Do you carry an EpiPen?*

YesNo
Covid Vaccine Status

Primary Physician Information
Physician
Office/Practice Name
Phone Number

Area CodePhone Number
Insurance Information
Insurance Provider
Policy Holder's Name
Policy Number
Group Number (if applicable)
Self Insured?

YesNo
Emergency Contact Information
Name of Emergency Contact Person:*
Relationship to Applicant:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone*

Area CodePhone Number
E-mail*

Travel Information

Please complete and submit the application even if you do not currently have a passport.
My team is serving in:
name of city and/or country
My team leader is:
Trip Dates
(Month, Year)
City, State of Departure
City, State of Return

Character Reference
Pastor / Leader / Mentor / Professor / Coach*

First NameLast Name
Relationship*
Email*
Phone Number

Area CodePhone Number

Verification & Agreements
I have read "The Role of the Righteous Wealthy" written by CRI Founder & President, Alan Pieratt, PhD, MnM.*

I agree

Permissions
I give permission to Children's Relief International to release the information provided herein to the appropriate CRI personnel. Authorization is also granted to CRI to contact me for further information.*

I agree
All of the information provided herein is true to the best of my knowledge. I understand CRI reserves the right to deny any applicant.*

I agree

Financial Clarity Agreement
A. Donors can give to your trip:

A.1 By Check:

Donors should make checks made payable and mailed to:

Children's Relief International
PO Box 2470
Rockwall, TX 75087

Your name should be entered in the memo.

A.2 By Credit Card:

Donors should go to the web address of your individualized trip donation page and click on the donate button.

To be provided after you have applied for your trip.

The donor can also call (800) 570-2217. As for finance.

B. Application fee and deadlines:

B.1 A $150 non-refundable application fee is due when you apply. As per IRS regulations, this fee is not tax deductible. Funds raised for your support cannot be used to cover this fee.

B.2 Airline tickets will be purchased approximately 3-4 months prior to the trip, depending on the destination. Funds raised from your donors can be used to cover this expense. However, if you are lacking support when tickets costs are due you are responsible to cover the remaining balance as the funds must be in your account prior to purchase.

B.3 In-country costs are due 6 weeks prior to your departure. Funds raised from your donors can be used to cover this expense. However, if you are lacking support when in-country costs are due you are responsible to cover the remaining balance as the funds must be in your account by the stated deadline.

C. Reimbursements:

C.1 If you paid out-of-pocket for the following expenditures AND if sufficient funds have come in from donors (above ticket, trip, in-country and ministry expenses) you can be reimbursed for:

• Airline tickets (B.2)
• In-country costs (B.3)
• Visa application costs
• Vaccination for Typhoid
• Vaccination for Hepatitis A
• Vaccination for Yellow Fever (if required by destination country)
• Malaria medications

C.2 Copies of receipts must be submitted for reimbursement. These receipts must be turned into the CRI finance office within two weeks of returning from the trip. Account balances and trip costs will be reconciled before reimbursements are issued.

C.3 If the team member / intern is 18 or younger: The parent or guardian may make contributions to CRI to cover the team member’s trip expenses. The parent or guardian may be reimbursed for these expenses, provided sufficient funding has come in from other donors for the team member.

C.4 If the team member/intern is age 19 or older: CRI can reimburse the team member but the parent or guardian cannot be reimbursed.

C.5 Personal donations are not tax-deductible if those donations are reimbursed.

C.6 Reconciled funds remaining in your account will go towards the work of CRI.

D. Trip Cancellation Policies:

D.1 Trip cancellation by team member/intern:

D.1.1 If you should need to cancel your trip, donations you have raised (after expenses) can be applied towards a trip during the next team season (up to one year). Contributions cannot be reimbursed to the donor.

D.1.2 If the ticket was purchased with personal money, CRI will reimburse the cost of the ticket minus the airline’s penalties and fees. Airline tickets cannot be transferred to another individual.

D.1.3 If the applicant is unable to make the trip, before airline tickets were purchased, the application fee can be applied towards a future trip during the next team season (up to one year). Application fees cannot be transferred to another individual.

D.1.4 If the applicant is unable to make the trip after the airline tickets were purchased the application fee is non-refundable and non-transferable towards another trip. Application fees cannot be transferred to another individual.

D.2 Trip Cancellation by CRI:

D.2.1 If the team member or intern is under the age of 19: The parent or guardian who has contributed to the team member's trip can be refunded after the account has been reconciled. The amount to be refunded will reflect airline and insurance cancellation fees and penalties.

D.2.2 If the team member or intern is age 19 or older: CRI can reimburse the team member but cannot reimburse the parent or guardian. The refund will be issued after the account has been reconciled. The amount to be refunded will reflect airline and insurance cancellation fees and penalties.

D.2.3 Remaining support funds can be held for one year to join a future CRI trip.

D.2.4 Remaining support funds can be transferred to another 501(c)3 organization for the purpose of an alternative missions opportunity.

D.2.5 The application fee is non-refundable and non-transferable.

Children's Relief International is a registered 501(c)(3) religious and charitable organization. Gifts to Children's Relief International are tax-deductible as allowed by law. All gifts, including those with donor preferences are under the complete discretion, control and administration of Children's Relief International to be used to further the ministries we serve.
I have read Children's Relief International's Financial Clarity Agreement and understand that I am responsible to abide by the stated policies and procedures. *

I agree

Release and Waiver of Liability

Children's Relief International
I blanks (“Participant”) am joining a short-term mission trip organized by Children’s Relief International within the year blank. Participant acknowledges, understands and agrees to the following:
1. There are risks involved in participating in the Mission Trip, and Participant hereby assumes all risk of injury, harm, damage, or death in connection with participation in it.
2. Neither Children’s Relief International nor its officers, directors, employees, agents, representatives or volunteers (collectively referred to as “CRI”) may be held liable in any way for any injury, harm, damage, or death that may occur to Participant as a result of participation in this Mission Trip, including but not limited to liability for all acts or omissions of third parties, the general risks of travel, government regulations and acts of God.
3. CRI is hereby released by Participant from any injury, harm, damage or death, which may occur while participating on the Mission Trip, including but not limited to claims based upon or related to negligence of CRI.
4. Participant agrees to indemnify and hold harmless CRI from and against any and all costs, liabilities, expenses, attorneys’ fees, damages, claims, losses, and actions arising out of any matter released or purported to be released herein, whether or not such costs, liabilities, expenses, damages, claims, losses, or actions arise out of sole or contributory negligence.
5. Participant authorizes CRI to render or obtain such emergency medical care or treatment for Participant as may be necessary should any injury, harm or accident occur while participating in the Mission Trip.
6. CRI requires Participant to purchase or pay for travel insurance for the Participant for the Mission Trip, including emergency medical evacuation insurance, the coverage of which may provide a basic level of protection that is not intended to replace any personal insurance of Participant. In case of incident, Participant is financially responsible for all such treatment and shall reimburse CRI for all costs and expenses incurred by CRI, if any, with respect to such treatment.
7. Participant is unaware of any physical, emotional or psychological reason why this Mission Trip might be injurious to Participant or others.
The signatory or signatories below is/are a (check one):*

Participant 18 years of age or older, orParticipant under 18 years of age and his/her Parent or Legal Guardian
Signature of trip APPLICANT:*

Clear
Printed Name*

First NameLast Name
Date waiver signed*

MonthDayYear
Date
If Participant is under 18 years of age:

Clear
Printed Name

First NameLast Name
Date waiver signed

MonthDayYear
Date

ALMOST THERE!
I plan to raise support through CRI to cover the cost of the trip.*

YesNo

Deposit Payment

Trip Deposit$150.00

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Thank your for applying for a short-term team with Children's Relief International. When you feel confident you have provided all necessary information, please click the submit button below. You will be contacted by our Teams department shortly.
Should be Empty:

General Information

Medical Information

Primary Physician Information

Insurance Information

Emergency Contact Information

Travel Information

Ministry Questions

Character Reference

Verification & Agreements

Permissions

Financial Clarity Agreement

Release and Waiver of Liability

Volunteer Disclosure Statement

ALMOST THERE!