Travel to ecuador.

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(as shown on passport)
Address *
Address
Phone *
Phone
Birthday *
Birthday
Passport Issued *
Passport Issued
Passport Expires *
Passport Expires
Parent Name (Father)
Parent Name (Father)
This section is required for those under 18 years of age
Phone Number (Father)
Phone Number (Father)
This section is required for those under 18 years of age
Parent Name (Mother)
Parent Name (Mother)
This section is required for those under 18 years of age
Phone Number (Mother)
Phone Number (Mother)
This section is required for those under 18 years of age
Address (Father or Mother)
Address (Father or Mother)
This section is required for those under 18 years of age
Emergency Contact *
Emergency Contact
Phone (Emergency Contact) *
Phone (Emergency Contact)
Address (Emergency Contact)
Address (Emergency Contact)
Policy Holder's Name
Policy Holder's Name
Insurance Company Phone
Insurance Company Phone
Medical History:
Check all that apply
Please check all immunizations that you have:
Consequences that may result in being sent home early will take place if rules are not followed. Use common sense Have good manners Wear appropriate clothing Be aware of your volume at night Respect leaders, locals, and your team Be aware of your belongings at all times If you ain't married, do not act like you is Girls: Don't be out late without a guy peer Have a Spanish speaker with you at all times Do not give money or things away to locals Do not tell strangers where we are staying Do not be rude, flirtatious or annoying Do not promise people anything Do not go anywhere by yourself Do not bring valuables Do not gossip or fight Do not complain Do not get drunk
1. WAIVER AND RELEASE: I release and forever discharge and hold harmless The Visit and its successors from any and all liability, claims and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from any activities I participate in with The Visit. I understand and acknowledge that this release discharges The Visit and its successors from any liability or claim that I may have against The Visit with respect to bodily injury, personal injury, illness, death, or property damage that may result from participating in activities with The Visit. 2. INSURANCE: I understand that The Visit does not assume any responsibility or obligation to provide you with financial or other assistance, including but not limited to medical, health, or disabilitybenefits or insurance. I expressly waive any such claim for compensation or liability on the part of The Visit beyond what may be offered freely by The Visit in the event of injury or medical expenses incurred by me. 3. MEDICAL TREATMENT: I hereby release and forever discharge The Visit from any claim whatsoeverwhich arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a participant with The Visit. 4. ASSUMPTION OF RISK: I understand that my participation with The Visit may include activities that may be hazardous to me including, but not limited to traveling by plane, ground transportation in a foreign country, bungee jumping, eating foreign food and other inherently dangerous activities. As a participant, I hereby expressly assume risk of injury or harm from these activities and release The Visit from all liability. 5. MEDIA: I grant and convey to The Visit all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by The Visit inconnection with my participation with The Visit. 6. OTHER: As a participant, I expressly agree that this release is intended to be as broad and inclusive aspermitted by the laws of the State of Colorado and that this Release shall be governed by and interpreted in accordance with the laws of the State of Colorado. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.
This section is required for those under 18 years of age 1. WAIVER AND RELEASE: I release and forever discharge and hold harmless The Visit and its successors from any and all liability, claims and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from any activities I participate in with The Visit. I understand and acknowledge that this release discharges The Visit and its successors from any liability or claim that I may have against The Visit with respect to bodily injury, personal injury, illness, death, or property damage that may result from participating in activities with The Visit. 2. INSURANCE: I understand that The Visit does not assume any responsibility or obligation to provide you with financial or other assistance, including but not limited to medical, health, or disabilitybenefits or insurance. I expressly waive any such claim for compensation or liability on the part of The Visit beyond what may be offered freely by The Visit in the event of injury or medical expenses incurred by me. 3. MEDICAL TREATMENT: I hereby release and forever discharge The Visit from any claim whatsoeverwhich arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a participant with The Visit. 4. ASSUMPTION OF RISK: I understand that my participation with The Visit may include activities that may be hazardous to me including, but not limited to traveling by plane, ground transportation in a foreign country, bungee jumping, eating foreign food and other inherently dangerous activities. As a participant, I hereby expressly assume risk of injury or harm from these activities and release The Visit from all liability. 5. MEDIA: I grant and convey to The Visit all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by The Visit inconnection with my participation with The Visit. 6. OTHER: As a participant, I expressly agree that this release is intended to be as broad and inclusive aspermitted by the laws of the State of Colorado and that this Release shall be governed by and interpreted in accordance with the laws of the State of Colorado. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.
This section is required for those under 18 years of age