To: Flight Coordinator

I understand that volunteer pilots of Wings for Children, Flight Division provide free air transportation service for qualified children of foster care, child abuse, neglect, abandonment, adoption and other to and from destinations, in the childs best interest.

Childs Name: _______________________________ Date of Birth: __________________________

The child listed above requires transportation:

From: ______________________________________ To: ____________________________________

For the following reasons: ______________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

who is ambulatory and physically able to be transported in a light, non-pressurized aircraft that has a need to avoid lengthy surface transportation. I understand that at least one (1) adult may accompany this child (or children), for the purposes above set out.

Social Service Worker Name __________________________Organization/Agency: ________________

__________________________________ Address: _________________________________________

___________________________________ Telephone: ________________ Fax: ______________

Signature: ________ ___________________________________ Date: _________________________

Sign & Print

____________________________________________

Please fax this letter to: Karole K. Jensen, Director

Wings for Children, Flight Division

Fax: 843-448-6445

Telephone: 843-448-9294