Americas Relief Template

Background Information

Today's Date		Trip Dates

Your Email Address

Please enter information below as it appears
exactly on your passport:

Name

Phone

Address

City/State/Zip

Sex		Date of Birth

Marital Status

Occupation

Mother's Maiden Name

Passport Number

Passport Expiration Date

Contact In Case Of Emergency

Name

Relationship

Address

City/State/Zip

Phone

Additional Questions

How many times have you traveled from the US to Cuba?

When was the last time you went to Cuba?

Under what license?

What is your reason for traveling to Cuba?

Release of Liability and Approval of Ministry

If I am accepted, I will:

Adhere to all of the instructions and guidelines provided by AmericasRelief Team regarding my trip, including the delivery of humanitarian aid to specified locations;
Keep a copy of my travel documents (i.e., flight ticket, authorization letter, etc.) for 5 years, should the authorities make an investigation;
Be responsible and prompt with all stated financial aspects related to my trip;
Participate in filling out a post trip report for AmericasRelief Team;
Wholeheartedly cooperate with AmericasRelief Team staff, personnel and representatives in the U.S. as well as Cuba.

In consideration for being accepted and allowed to participate in this project, and activities associated with its programs and locations, I personally assume responsibility for my actions, and release AmericasRelief Team and any associated groups or ministries, their board members, employees, and missionaries from loss, injury, or damage to myself or my property; provided that nothing contained herein shall excuse AmericasRelief Team and any associated groups or ministries, their board members, employees, and missionaries from the responsibility to act with reasonable care for the safety of myself or my property.

Typing your full name in this box
constitutes your electronic signature:

Signed		Date