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Mail all fees (checks should be written to: Choctaw Missions) and forms to: (Be sure forms are for the current year before printing.)

 

Nick & Stacey Hauck

c/o Choctaw Mission Trip

528 N Chamberlain Ave

Rockwood, TN 37854

 

Do Not Send any paperwork to UMVIM. Send to us. Thanks.

 

The first form to send in is the Application and must be sent to us with the deposit of $25.00. 

                                           APPLICATION

 

 

(If for some reason you cannot open the forms, you may have to download first or please contact us.)

 

The next forms are: the Missioner Profile/Release of Claim form as well as the Medical Info/Release form. These  forms are all mandatory, due to us by May 16 with balance of money.

 

 

MISSION PROFILE/RELEASE FORM

 

 

 

 

 

 

Medical Information/Release and Parental Consent (for under 18) forms must be notarized.

 

Please note that you must be up to date on your tetanus shot.

 

 

 

 

 

 

MEDICAL RELEASE                            PARENTAL CONSENT

            FORM                                                      FORM

The application, mission profile/release, and medical information/release forms need to be filled out by everyone. The parental consent form is for under 18 year olds only. Remember parents must sign all forms if team member is under 18.

 

Everyone must fill out these forms only:

 

        Application with a statement (as per application)

        Missioner's Profile/Release Form

        Medical Information/Release (must be notarized)

        Parental Consent (must be notarized) (under 18 only)

 

For those under 18, all forms must be signed by parents also.

 

All forms must be turned in by May 16 with your balance of $250.00 unless already paid in full. Send all paperwork to us.

 

I know we may be repeating ourselves but these things are very important. The forms need to be mailed to us not to UMVIM. Mail (with check written to Choctaw Missions) to:

Nick & Stacey Hauck

c/o Choctaw Mission Trip

528 N Chamberlain Ave

Rockwood, TN 37854

 

Email: shauck318@yahoo.com

 

Contact us for more information and questions.

PLEASE PRINT, COMPLETE 

 FORMS, AND SEND TO US!

 

If it is impossible to print the forms, let us know if we need to email, fax, or mail them to you. Thank you!

 

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