Profile & Release of Claim Form
Required for each Team Member
Email address *
Project Name: Highland Support Project
First Name(s) *
Exactly as it appear on your passport
Your answer
Last Name(s) *
Exactly as it appear on your passport
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Home Phone
Your answer
Cell Phone
Your answer
Address
Your answer
Do you have any allergies?
Please explain
Your answer
Do you have any dietary restrictions?
Please explain
Your answer
Passport #
If we are buying your flight ticket*
Your answer
Where was issued your passport?
Your answer
Expiration Date
MM
/
DD
/
YYYY
Team Leader *
Your answer
Departure Date
MM
/
DD
/
YYYY
Return Date
MM
/
DD
/
YYYY
Emergency Contact
Full Name
Your answer
Relationship with you
Your answer
Cell Phone
Your answer
Email of Emergency Contact
Your answer
Agreement
In consideration of the opportunity to participate in the project described above as a volunteer, and in consideration of other obligations incurred by the organization, please review the following agreement.

- I agree to be respectful of other ideas and other cultures,

- I agree to cooperate at all times with the team leader concerning our work and life together including daily assignments, food, lodging, and transportation, and to stay with the team from beginning to end.

- Further, I hereby release and discharge the organizations which assisted in these arrangements, their agents, employees, and officers, from all claims, demands, actions, judgments, and executions which I ever had, or now have, or may have, or which my heirs, executors, administrators, or assigns may have or claim to have, against the organizations, their agents, employees, and officers, and their successors or assigns for all personal injuries to property, real or personal, caused by, or arising out of, the above described service. I intend to be legally bound by this statement.

- I hereby acknowledge that by engaging in this service trip, I am subjecting myself to certain risks voluntarily, including and in addition to those risks which I normally face in my personal and business life, including but not limited to such things as health hazards due to poor food and water, diseases, pests, and poor sanitation; potential danger from lack of control over local population; potential injury while working; and inadequate medical facilities, etc.

The validity, construction, and interpretation of this PROFILE AND RELEASE OF CLAIM form shall be governed by and construed in accordance with the domestic laws of the State of Virginia, in which Highland Support Project is located.

Refunds

The initial $250 deposit toward registration and airfare is non refundable. Once airfare is purchased, the remaining airfare cost is also non refundable. If a trip participant must unfortunately withdraw from the trip more than 30 days before departure date, we can refund the remainder of their payment in full. However, once we get into the month right before your team departs, we cannot refund any payment, because all payments have already gone toward purchasing everything for the trip.

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