This is  a bit daunting, but don't worry it will be worth it!

Name *
Name
Address *
Address
Phone Number *
Phone Number
Birthday of Beneficiary
Emergency Contact Phone Number
Put Pending If You Have Applied But Not Yet Received Your Passport
How Did You Hear About This Trip?
List Any Overseas Experiences You Have Had:
What are you expectations of this trip.
Do You Speak Any Foreign Languages?
Please List Your Top Three Skills that could be useful in Haiti.
What Is Your Blood Type?
What Is The Date Of Your Last Tetanus Shot?
List Any Allergies, Physical Limitations, Or Restrictions, Including Chronic Diseases:
Please List If You Have Any Dietary Restrictions?
I agree that ONE FOOT RAISED INC. is not to be held responsible for expenses incurred by illness or accident while or subsequent to my stay in Haiti. I agree to provide my own personal accident/health insurance apart from ONE FOOT RAISED INC. travel insurance.
I agree to assume all normal and foreseeable risks associated with travel to, from and within the Country (including but not limited to natural disasters, terrorism, political unrest, and contraction of illness) and releases Company and its affiliates from any responsibility for such risks.
I acknowledge that the carriers, hotels and other suppliers (the “suppliers”) providing services in connection with the missions trip are independent contractors and are not agents, employees or representatives of, or joint venturers with, the Company or its affiliates and releases Company and its affiliates from any responsibility for the actions or omissions of such suppliers.
I agree that the Company shall have no liability for any personal injury, property damage or other loss, accident, delay, inconvenience, or irregularity which may be caused by (a) any wrongful, negligent or unauthorized acts or omissions on the part of any of the suppliers or their agents, (b) any defect in or failure of any vehicle, equipment or instrument owned, operated or otherwise used by any supplier, or (c) any wrongful or negligent acts or omissions on the part of any other party not under the control of the Company
I agree not to sue or otherwise hold ONE FOOT RAISED INC responsible for any injury, damage, or loss resulting to the undersigned or the undersigned’s property in connection with the undersigned’s participation in the trip to the Country.
I accept full responsibility for luggage and other belongings brought on the trip by the undersigned.
I agree to be responsible for any injuries, damages or losses caused by the undersigned while the undersigned is traveling with representatives of the Company or while the undersigned is in the Country.
I agree to be responsible for any injuries, damages or losses caused by the undersigned while the undersigned is traveling with representatives of the Company or while the undersigned is in the Country.
I, acknowledge that he/she has been informed that United States citizens traveling outside of the United States are required to carry documentation of United States citizenship, which may include a valid passport or notarized copy of the citizen’s birth certificate with a raised seal, and a valid picture I.D. (such as a driver’s license).
I have read the Personal Commitment and agree to abide by these standards.
Signature
Date