15/10/2024 / Youth Ministry Forms FORM A – CONTACT DETAILS and CONSENTContact DetailsName & Surname (according to your passport)(Required) First Last This field is hidden when viewing the formNationality at Birth(Required)This field is hidden when viewing the formPresent Nationality(Required)Address(Required) Street Address Address Line 2 City ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands ID Card No.(Required)Email(Required) Mob. No(Required)*we will add you to a facebook group chat and WhatsApp private group which will make your number visible to all subscribersPlace of Birth (eg: Pietà )(Required)Date of Birth(Required) DD slash MM slash YYYY Your occupation(Required)Your talents: playing instruments, drawing, cooking etc..(Required)Passport No.(Required)Date of Issue(Required) DD slash MM slash YYYY Expiry Date(Required) DD slash MM slash YYYY Upload a copy of your passport(Required)Max. file size: 32 MB.This field is hidden when viewing the formIs your Father still alive?(Required) Yes No This field is hidden when viewing the formFull Name of your Father(Required)This field is hidden when viewing the formIs your Mother still alive?(Required) Yes No This field is hidden when viewing the formFull Name of your Mother(Required)Have you been previously denied entry into another country?(Required) Yes No Have you been convicted of any offence under any system of law?(Required) Yes No If yes, what was the case?Health/Medical Information & ConsentAny allergies/dietary requirements that we need to know?(Required) Yes No List the Allergies/dietary requirements here:Any medication that you take?(Required) Yes No List the medications here:Medical Consent(Required)In the event of a medical emergency, I want to be given assistance by a trained First Aider and if I become unable to take my own personal medical decisions during this experience, I give the right to Segretarjat Missjonijiet Agostinjani AMIGOS leading team to take any medical decisions on my behalf. I agreeIn Case of EmergencyName & Surname(Required) First Last Contact No.(Required)Relationship to you(Required)Risk Disclaimer, and other consentRisk Disclaimer(Required)I acknowledge and give consent to travel and participate in this missionary experience 2025 by Segretarjat Missjonijiet Agostinjani AMIGOS (Maltese Augustinian Province) entirely at my own risk. I agree to follow the reasonable instructions of leaders and event organisers and comply with the rules of Segretarjat Missjonijiet Agostinjani AMIGOS. I agreeFit for travelling/Cancellation of Experience(Required)I acknowledge and give consent to travel and participate in this missionary experience 2025 by Segretarjat Missjonijiet Agostinjani AMIGOS (Maltese Augustinian Province) entirely at my own risk. I declare that I presently am or will be sufficiently physically and mentally fit to travel for the purpose by June 2025 before participating in this missionary experience in Iquitos, Perù. Should AMIGOS decide to cancel this experience, or if I resign or because of any medical reason, the doctor or medical professional declares that I am not fit for travelling, I promise to pay for the associated non-refundable costs incurred by Segretarjat Missjonijiet Agostinjani AMIGOS. I agreeNon-refundable deposit(Required)I understand and agree that should my application be approved by Segretarjat Missjonijiet Agostinjani AMIGOS’ board; I shall secure my participation by paying a non-refundable deposit of €500 (by 30th November 2024) via Bank Transfer which will be deducted from the travel costs. (instructions will be received by email upon completion of this form) Beneficiary Name: Fr Mario Abela osa Address: Kunvent S. Tumas minn Villanova, Triq J. Zammit Tabona, Pietà , PTA 1331 Account: 40010188817 IBAN: MT58VALL22013000000040010188817 I agreeParticipation of events organised by AMIGOS(Required)I also agree that I must participate in all of the events and meetings held by Segretarjat Missjonijiet Agostinjani AMIGOS in preparation for this Missionary Experience. In the event of being indisposed for any activity or meeting, I agree that the committee or the person responsible is to be informed beforehand. I agreePhoto and Video Consent(Required)I give consent to Segretarjat Missjonijiet Agostinjani AMIGOS to make use of any photos/videos taken during local events and abroad on social media and other promotional campaigns including other media of the Maltese Augustinian Province. I consent to the information being retained and used by AMIGOS for such purposes and to disclose such information to AMIGOS committee members as may be necessary or appropriate. I agree that any representation of AMIGOS on any local media is to be priorly authorised by the Segretarjat Missjonijiet Agostinjani AMIGOS board. I agreeGDPR Consent(Required)In valuing the privacy of personal data, Segretarjat Missjonijiet Agostinjani AMIGOS, will use the data collected from this form for the purpose of registering your interest in this Amigos Missionary Experience only. This will be used to contact you and keep you updated on this Experience and other related youth events. Personal data will be stored, handled and processed, in a respectful and lawful way in accordance with the General Decree on the Protection of Data (GDPD) of 2018 (accessible at: http://thechurchinmalta.org/files/page/GDPD.15348463124.pdf) and the General Data Protection Regulation (EU)2016/679. You have the right to opt out of consent and ask that collected data to be deleted by sending an email to: missions.amigos@gmail.com or youths@agostinjani.org I give consent to the request of information overleaf by AMIGOS for administrative, promotional and medical purposes and understand that I may access and amend such information. I agreeName & Surname of the Participant(Required) First Last Signature of the Participantto be signed when printedDate of Application(Required) MM slash DD slash YYYY FORM B – Terms and Conditions of the AMIGOS PERÙ MISSIONARY EXPERIENCE 2025Terms and Conditions of the AMIGOS PERÙ MISSIONARY EXPERIENCE 2025(Required)BEFORE THE EXPERIENCE • Every person who applies to do this experience is encouraged to participate in the activities organized in preparation for this Missionary Experience. These activities include, weekly formation meetings, fundraising activities, live-ins, moments of prayer, send off mass before the departure and other activities that the group organizes. • If during the preparation time the person does not take part or fails several times without reason, the director of the experience has the right to stop this person from taking part in the experience. • The group is officially closed after the flights are paid, when it is the right moment to do so. • It is in the interest of every participant to ask the Health Department and take the necessary vaccines required for Perù. COSTS INVOLVED • Every person doing the experience will pay the flights and other transfers together with the insurance as a group. These will be booked by the leader/director who is taking care and not everyone for himself/herself. • Other costs related to snacks and other expenses during the experience are paid personally. DURING THE EXPERIENCE • The experience, in addition to working manually in repairing roofs, building, painting etc, it is also a spiritual experience in the form of community living with the Augustinian friars living there. • AMIGOS helps the participants to enjoy the experience abroad, however it is important to keep in mind that this is not a holiday, but a missionary experience. • Every participant needs to respect the Augustinian Community who is welcoming and taking care of the group by: o Wearing decent clothing o Not consuming alcohol personally in the individual’s room o Not allowing other persons outside the group entering the Augustinian community or the places where the group will be living. o Not going out of the community building without the permission of the director (since the reality is different from Malta and it can be dangerous to go out alone) o Being punctual to the different moments celebrated and lived throughout the day. • The daily program of the group will respect the Community’s program. • Each person is to live this experience in a community by working together as a group in the best possible way and see what is best for the community during that moment. • Every person is encouraged to do everything possible to live in harmony with others so that it is an enriching and remarkable experience for everyone. • This experience will be organized by Fr Mario Abela osa and Fr Terence Spiteri osa who will help and take responsibility in case of emergency. • If any emergencies or decisions arise and decisions need to be taken, during those days of the experience, each person must adapt to what arises according to the decision of the director after having discussed with the participants. • Every person is asked to take part in all the moments organized by the director, unless there is a particular reason that is discussed before. • An evaluation of the experience is done frequently so that the group can discuss what can be changed for the following days. • The organization group of this Missionary Experience is not responsible for what may arise during the stay in Perù that is not within its control. SPIRITUAL EXPERIENCE • During the days of the experience, there will be several moments of prayer and sharing of experiences together with celebrations of the eucharist. • Each day begins with a short moment of prayer and there is a daily celebration of the eucharist, which everyone is invited to participate. I, the undersigned, have read these points as a guide for the AMIGOS Missionary experience 2025 and I participate in this experience according to these terms mentioned above.Name & Surname of the Participant(Required) First Last Signature of the Participantto be signed when printedDate of Application(Required) MM slash DD slash YYYY Administrative PurposesName & Surname of the DirectorSegretarjat Missjonijiet Agostinjani First Last Signature of the Directorto be signed when receivedDate of Application(Required) MM slash DD slash YYYY Δ