Trip Forms & Waivers Step 1 of 10 – Intro 10% We are so glad that you have decided to visit Malawi with VIP! Those who make this journey report experiences that expand their view of the world and what God is doing in it. You will learn to see hospitality, faith, community, poverty, and resilience in new ways. We are not in the business of creating “travel/tourist” experiences. Instead, our hope is that this trip would be a transformative opportunity where God meets us, convicts us, and leads us to deeper and deeper change. After completing the following forms, we will be able to tailor your experience in Malawi to your gifts and hopes as well as the needs of the villagers. God bless you and your journey. Sincerely, Liz Heinzel-Nelson Executive Director & Trip Coordinator Villages In Partnership BEFORE YOU BEGIN If you need to pause before completing the forms, click “Save and Come Back Later.” You will be sent a link via email where you can continue the forms at a later time. You will need the following information in order to submit these forms: Passport info Emergency medical info: Medical history Blood type Primary physician’s contact info Medical insurance info Emergency contact info We do not share any of your information. Trip InformationWhen are you going to Malawi?* Friendship Trips July 22-29, 2023 July 29-Aug 5, 2023 (Women-to-Women) Aug 2-5, 2023 (Health Center Opening) Aug 2-9, 2023 Other Medical Trips Spring 2024 (Medical) Other When are you planning to visit Malawi? NOTE: Dates for traveling without a group need to be approved by VIP staff.Trip Payment*The full cost of Ground Fees for a Trip are: $1,500 – Medical trip $1,300 – Medical trip without safari $1,400 – Friendship/Beekeeping/Women trips $950 – Health Center Grand Opening Trip This fee, payable to VIP, covers food, lodging, translators, and in-country transportation but does not include airfare or insurance. A non-refundable deposit of $500 should be turned in 90 days prior to the trip. Full payment is due 60 days prior to the Trip. I have already paid. I am mailing in a check. I will pay online/by phone. My fess will be covered by…(church, school, etc) Who will be covering your Ground Fees for this trip? Checks should be made payable to: Villages In Partnership PO Box 52 Allentown, NJ 08501 This information will be provided again after you submit these forms.The link to make an online payment will be provided after you submit these forms.This trip is less than 90 days away. Please make arrangements for payment of a $500 non-refundable deposit as quickly as possible.This trip is less than 60 days away. Please submit these forms as soon as you can. If you haven’t already done so, make arrangements for full Ground Fees payment and purchase flights. Personal InformationName* Preferred First Name Last Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Phone*Phone Type Mobile Landline Date of Birth* MM slash DD slash YYYY Gender* Male Female Other/Prefer not to say Passport InformationPassport Checks I do NOT have a valid passport. My passport has less than 2 blank pages. International travel requires you to have a valid passport with at least 2 blank pages. If you have not started the application for a new passport, please do so as soon as possible.Country of Citizenship* 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 SaharaYemenZambiaZimbabweÅland Islands Country Name as it appears on your Passport* Passport Number* Passport Expiration Date* MM slash DD slash YYYY Are you legally able to leave the US?* Yes No Returning Participant?Have you been to Malawi with Villages In Partnership before?* Yes No Volunteer Gifts & AbilitiesCheck any that apply.Construction Carpentry/Building Engineering Electrical Painting Masonry Roofing Other… What other construction skills do you have? Medical CPR/First Aid Physician Nursing EMT Dental Veterinary Medicine Pharmacist Med Team Support Other… What other medical skills do you have? Spiritual Bible Study Counseling Prayer Preaching Teaching Other… What other spiritual skills do you have? Business Accounting Advertising/Marketing Admin/Organization Computers Writing (articles, blogs) Other… What other business skills do you have? Arts/Music Singing Instruments Illustration/Painting Graphic Design Photography Videography Other… What other artistic skills do you have? Other Beekeeping Farming/Gardening Livestock handling Cooking Sports Children’s activities Other… What other skills do you have? Are you a student?*NoHigh SchoolUndergraduateGraduateWhat are you studying? When do you expect to graduate? MM slash DD slash YYYY Occupation Medical Professionals – What is your specialty? Personal ExpectationsPlease describe your expectations for this trip.*This will be an experiential learning trip. What do you hope to learn? What do you hope to contribute? How do you hope to grow as a result of this trip? What emotional or health concerns may affect you on this trip? What fears do you have? Medical InformationThis information will be kept confidential and used for emergency medical purposes only.Since you have been on a trip with VIP before, we will skip ahead in the questions. However, the following medical questions are required for ALL trip participants to ensure we have up-to-date info in case of emergency.Name as it appears on medical records:* What is your current state of health?* Have you had any serious illnesses in the past year?* Yes No Please explain: Please list any history of major illness or surgery that may affect you during the trip:*If none, type “None”.Illness/SurgeryDateEnd date (if applicable) Please list any allergies you have:*Include drug, food, animal allergies, etc. If none, type “None”. Please list any other restrictions you have (physical, psychological, or dietary):*If none, type “None”. Please list any medications you are currently taking:*If none, type “None”. Enter one medication per line, and use the + to add more lines if needed. Date of your most recent tetanus shot:* MM slash DD slash YYYY Date of your most recent COVID vaccine or booster: MM slash DD slash YYYY Physician InformationName of your physician:* Physician's phone:*Physician's address:* Medical Insurance InformationHealth Insurance Provider:* Policy Number:* Does your health insurance provide coverage for you while you are outside of the US?*Each traveler is responsible and required to enroll in travel medical insurance. It is the individual responsibility of each team member to attain such insurance prior to traveling on this trip. Yes No InsuranceCheck*If your health insurance provider does not provide coverage outside the US, there are inexpensive options available, such as a Per-Trip Medivac policy from AIG Travel Guard. I acknowledge that I will need to enroll in travel medical insurance prior to the trip at my own expense. Emergency ContactEmergency Contact Name(s)* Relationship to you* Emergency Contact Phone Number*Alternate Phone NumberEmergency Contact Address Emergency Contact Email* Emergency AuthorizationTo Whom It May Concern: I give any licensed, practicing physician or hospital full authority to provide emergency medical treatment for me in the event such treatment is needed or necessary and I am not able to make such a decision. I also hereby give my permission for a licensed, practicing physician to administer whatever medical treatment he/she may deem necessary for me in the event of any medical emergency affecting me.Are you over 18? I am 18 years of age or older. Signed* By typing your name above, you are digitally signing this Emergency Authorization.Date* MM slash DD slash YYYY HiddenParticipant SignatureBy entering your name above, you are digitally signing this Emergency AuthorizationParent or Guardian Signature* Required if Participant is under 18 years of age.HiddenParent or Guardian SignatureBy entering your name above, you are digitally signing this Emergency AuthorizationDate* MM slash DD slash YYYY Waiver of LiabilityThis is a legal document; please read carefully.This Release and Waiver of Liability (the “Release”) executed on Date* MM slash DD slash YYYY Today’s dateby* Participant Name (the “Volunteer”)in favor of Villages In Partnership (“VIP”), a nonprofit corporation organized and existing under the laws of the State of New Jersey, USA. I, the Volunteer, desire to work as a volunteer for Villages In Partnership and engage in the activities related to being a volunteer for a work team. I understand that the activities may include but are not limited to, traveling to and from other countries, traveling to and from other cities and towns, consuming food and living in accommodations available and provided in the foreign country, working with VIP staff, volunteers, or mission partners, and engaging in other mission-related activities. I hereby freely and voluntarily, without duress, execute this Release under the following terms: Waiver and Release.I, the Volunteer, release and forever discharge and hold harmless VIP and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my work with VIP. I understand and acknowledge that this Release discharges VIP from any liability or claim that I, the Volunteer, may have against VIP with respect to any bodily injury, illness, death, or property damage that may result from my participation with a VIP Team. VIP does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death or property damage (see insurance requirements below). Insurance.I, the Volunteer, understand that, except as otherwise agreed to by VIP in writing, VIP does not carry or maintain health, medical, or disability insurance coverage for any volunteer. VIP requires all work team members to have appropriate Travel insurance. Insurance is paid for by the individual Volunteer and is required prior to travel. Medical Treatment.Except as otherwise agreed to by VIP in writing, I hereby release and forever discharge VIP from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my time with VIP. Assumption of the Risk.I understand that my time with VIP may include activities that may be hazardous to me, including, but not limited to, construction activities, loading and unloading of heavy equipment and materials, and local transportation to and from the work sites. SO, I recognize and understand that my time with VIP may, in some situations, involve inherently dangerous activities. I also understand that in addition to consuming local foods and living in accommodations that are available in Malawi, I may be traveling to and from locations which pose risk from terrorism, war, insurrection, disease or criminal activities. I hereby expressly and specifically assume the risk of injury or harm in these activities and release VIP from all liability for injury, illness, death, or property damage resulting from the activities during my time with VIP. Media.I, hereby, authorize the making of photographs, video and audio recordings, or other memorializing of this event and my participation therein, and the publication or other use thereof in social media, printed materials, or other materials for VIP. I, hereby, waive any right to compensation that I otherwise might have to limit or control such. Other.I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of New Jersey and the United States of America, and that this Release shall be governed by and interpreted in accordance with the laws of the State of New Jersey. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provision of this Release which shall continue to be enforceable. To express my understanding of this release, I sign here. By signing digitally, I consent to do business electronically. Participant Signature* By entering your name above, you are digitally signing this Waiver of Liability.HiddenParticipant SignatureDate Signed* MM slash DD slash YYYY Parent or Guardian Signature* Required if Participant is under 18 years of age.HiddenParent or Guardian SignatureBy entering your name above, you are digitally signing this Waiver of Liability.Date Signed* MM slash DD slash YYYY Release of RightsWe live in a world that is full of rights. Our particular culture is one where we take pride in our rights. We ask you to consider laying down your rights on this service trip. Not to lay them down for better or for worse, but to lay them down so that we can more fully partner with those whom we seek to serve. Our prayer is that we will be known as humble and loving servants, not as entitled and self-focused individuals. Before signing this, please spend time to consider the weight of each right you are willing to give up (Romans 12:1). I GIVE UP MY RIGHT TO: A comfortable bed Having three meals a day Having familiar food Dressing fashionably Seeing results Having it my way Control of others Control of circumstances Having pleasant circumstances Making decisions Taking offense Being successful Being understood Being heard Being right. I ENTRUST TO GOD: My strength, health and endurance My likes and dislikes of food My security in God God’s purposes and fruit in God’s timing My need for the Spirit’s control God’s workmanship in others My circumstances to God’s purposes in making me Christ-like The privilege of suffering for God’s sake God’s sovereign hand on my life My deepest needs My security in God’s love My reputation My need for recognition My need for God’s righteousness My life and my loved ones Participant Signature By entering your name above, you are digitally signing this Release of Rights.HiddenParticipant SignatureBy entering your name above, you are digitally signing this Release of Rights.Date Signed MM slash DD slash YYYY Privacy Policy* I agree to the privacy policy. Thank you for completing these forms and waivers.When you click “Submit Forms,” you will receive an email with all the information you submitted for your records. Please review it and contact us if you need to make any updates or changes.