Application

Personal Information

Name:

Date of Birth:

Home Address:

City, State, Zip Code:

Country:

Home Phone:

Work Phone:

E-mail Address:

Name of Emergency Contact:

Home Phone:

Work Phone:

Relationship to you:

References

Name, address, and phone numbers for two personal references:

Employment Information

Your Position/Title:

Agency/Company Name:

Address:

City, State, Zip Code:

Phone:

Supervisors Name:

Dates of Employment:

Duties:

Education & Experience

Education/Licenses/Certifications:

Community Service/Experiences/Responsibilities involving children:

Personal Interests/Specialties:

Do you have any physical limitations or medical conditions that would prevent you from safely traveling to and working at the PRAY mission in Brazil? If yes, please explain:

Why do you wish to be a volunteer for PRAY?

When are you interested in going?

What length of time would you like to stay?

Have you ever traveled to another country for more than 2 weeks?

If so, when, where, and under what circumstances?

Do you speak any foreign languages? If so, which ones?

Agreement and Release Statement for P.R.A.Y. Volunteers

I am applying for volunteer services for P.R.A.Y. (Project Rescue of Amazon Youth) whose mission is to help children in northern Brazil who are abandoned, orphaned, or otherwise in need. I certify that all statements made in my application are true, accurate, and complete. I hereby expressly authorize P.R.A.Y., its Directors, agents, and employees to investigate in any manner they deem appropriate, at their sole discretion, my medical, health, educational, employment, community service or professional background, public or private records, including but not limited to law enforcement, court records and personal references. I further consent to and authorize P.R.A.Y. to communicate with any and all of my previous and current employers relating to my work record and experience.

In consideration of being evaluated for volunteer service with P.R.A.Y., I hereby release and forever discharge P.R.A.Y., its Directors, agents, and employees from any and all claims, demands, damages or liability relating to or arising out of the requesting or furnishing of any information relating to my medical, health, educational, employment, community service or professional background, public or private records including but not limited to law enforcement, court records and personal references as described above.

In consideration of PRAY arranging a volunteer assignment for me, and with the intention of binding myself, my heirs, legal representatives, successors, and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE P.R.A.Y., its Directors, agents, employees, volunteers, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my selection as a volunteer by, or my service as a volunteer with PRAY whether or not due to PRAYs negligence, strict liability, or any other breach or fault. This includes, but is expressly not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss or cost.

This document shall be construed according to the laws of the State of Kansas. If a dispute should arise with respect to the meaning of any of the terms of this document, the rule of construction that a document is constructed against the party preparing such document shall specifically not be applicable to the interpretation of this document.

This General Release represents the entire agreement of the parties hereto and supersedes any and all prior or contemporaneous oral or written understandings, statements, representations, or promises. All of the terms hereof are contractual and not mere recitals.

I acknowledge that I have carefully read this General Release, know and understand the contents thereof, and that this document was freely and voluntarily executed. I acknowledge that I was given the opportunity to seek independent legal counsel on any and all matters here in before I signed this General Release.

Printed Name:

Signature:

Date: