2022 Ghana Intake Form
TENTATIVE: December 26-January 4th, 2023

RESERVATION OF RIGHTS: I acknowledge that DJAF, Inc., and D&J Global Inc. reserves the following rights that it may exercise in its sole discretion: (i) the right to cancel the Trip, and (ii) the right to make alterations, changes, and modifications in any part of the Trip itinerary and the activities in connection therewith. I agree and understand that by taking part in this event I grant the organizers full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity, or other purposes to help achieve the groups aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, website, press releases, and funding applications.
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Danny & Jazmin Adjei Foundation | Experience Ghana 2021 Trip {Episode 1}
First & Last Name *
Date of Birth *
Passport Number & Expiration Date *
Email *
Phone Number *
Home Address *
Height & Weight *
Hair & Eye Color *
T-Shirt Size *
Afrochella Festival : December 28-29, 2022
Will you be attending the Afrochella Festival?
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Do you currently have or have had any of the following medical conditions? Check all that apply:
Medication Allergies *
Are you currently taking any medications? If so, please list them below.
Blood Type *
Dietary Restrictions *
Food Allergens *
Health Insurance Name, ID Number, and Group Number: *
Travel Insurance Information
Emergency Contact #1 (Include Name, Number and Email) *
Emergency Contact #2 (Include Name, Number and Email) *
Signature *
Date *
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