Standards of medical care vary widely across the globe. In order to have a safe experience abroad, it is important that we are aware of any health concerns you may have so as to best advise you on appropriate resources available prior to your departure. Living overseas can create emotional and physical distress for any participant. In some cases, mild disorders can become very serious conditions while living in a new environment.

Please complete the form below regarding your current health status. This information is not used for purposes of approval for GEI programs. It will be kept strictly confidential and will only be used in matters related to your program and your health care while overseas.

*Please inform us immediately, should you incur any pre-trip injuries that will affect your participation in this program.*

Predisposing medical conditions

Physical limitations

Allergies

Psychological / emotional conditions

Medical conditions

Injuries or accidents

Surgeries

Current medications

Religious beliefs

Dietary restrictions

I, the undersigned, understand that travel to GEI's program destinations involves a number of risks, including the risk of violence, trauma, serious injury, illness, permanent disability or death. I understand that participation in this program exposes me to all of these risks, and I am choosing to participate voluntarily.

I acknowledge by signing this document that I have carefully read this Waiver and understand the risks in participation including pecuniary loss, serious injury and, in extreme cases, permanent trauma or death. These risks include, but are not limited to:

• Motor vehicle accidents,
• Aircraft accidents,
• Natural disasters such as but not limited to hurricanes, tornados, floods, seismic activities,
• Health emergencies/illness/lack of access to medical services,
• Injuries or death due to the limits of my physical strength, coordination, sense of balance or ability to follow instructions and directions given by the program leaders,
• Political, environmental or social instability at the program destination(s),
• Crimes/violence against my person or property, or
• Pecuniary or monetary loss associated with program cancellation or delay in travel.

I understand that GEI cannot ensure or guarantee my health or safety. I hereby assume all risks associated in any way with my voluntary participation in the GEI program. I understand there are significant elements of risk in any travel. I also understand that GEI reserves the right, in extraordinary circumstances, to cancel, delay or reschedule the program at its discretion, for any reason it deems necessary. I understand it is my sole responsibility to obtain the insurance necessary to cover any monetary losses or other issues arising from trip delay, cancellation or rescheduling for reasons of extraordinary circumstance.

I, the undersigned, hereby release, waive, discharge and covenant not to sue GEI, its respective officers, directors, managers, partners, employees, agents, designees, contractors, subcontractors, representatives, successors and assigns, and all persons conducting, directly or indirectly, my involvements as a program participant, or any program participants, (hereinafter collectively referred to as ‘Releasees’) from any and all liability, rights, claims, demands, actions, causes of action, expenses and damages whatsoever arising out of or related to any loss, damage or injury that may be sustained by me or my heirs, personal representatives, guardians, successors or assigns.

This release of liability covers any and all potential sources of liability whether arising from any injury, act or omission relating to my program participation, or caused by any act or omission of the Releasees, or other circumstances arising from traveling for or participating in the activities on the program, or while in, on or upon any premises where the activities take place.

I voluntarily assume full responsibility for any risks of loss, sustained by me, or any loss or damage to my property as a result of being engaged in such activities, whether caused by the negligence of Releasees or otherwise. I hereby release and forever discharge Releasees from any claims whatsoever which arise or may hereafter arise on account of any first aid, treatment or service rendered in connection with participation in the GEI program.

If a provision or any part of this Waiver is or becomes illegal, invalid or unenforceable in any jurisdiction, that shall not affect the validity or enforceability in that jurisdiction of any other provision of this Waiver; or the validity or enforceability in other jurisdictions of that or any other provision of this Waiver.

Arrival

Departure

Airport pickup and drop-off

Optional Activities

If you would like to join one or both activities below, please note that you need to arrive few days before the beginning of your rotation. For example, if your rotation starts on a Monday, you need to arrive on the Friday or Saturday before, to join the activities on Sunday.

• Activity 1: Cultural Introduction Day

In this guided tour, you will explore Kigali and learn about Rwanda’s history. While a drive through the colorful suburb of Nyamirambo offers first fascinating glimpses of life in less advantaged urban neighborhoods, it also provides the opportunity to hear about the Rwandan kingdoms in pre-colonial times and the massive battle that took place right in this area. The first stop of the day is the Nyamirambo Women Center (NWC), a self-help group, located in the multi-cultural hub of Nyamirambo. Nyamirambo is a merchant quarter with a majority Muslim population and with numerous religious, cultural and historical sites. The center was established to bring together disadvantaged and hardworking women from different social, cultural and religious backgrounds to support them with formal and informal education, so that they have better opportunities for employment. The NWC offers a walking tour in this neighborhood followed by a traditional Rwandan lunch prepared and served in a home environment by one of its members. In the afternoon, the main activity is a visit to the Kigali Memorial Center in the suburb of Gisozi. A visit to this most prominent of genocide memorials in the country is a must for every visitor and many Rwandans, including classes of school children. A well-designed museum, the Center introduces you to the story of the Rwandan genocide and tries to provide answers to the question of how it could have happened. In addition, you will find an exhibit that provides context and information on genocides from other parts of the world.

• Activity 2: Kinyarwanda Class

8-hour private beginner class in the Kinyarwanda language.

By accepting this Publicity Release Agreement, I confirm that I understand and agree to the following representations and terms.

I irrevocably grant to Global Engagement Institute (GEI) and its partners the right to use my name, image, biographical information and personal testimonial statements (Personal Information) with regard to my interview, photograph and/or video taken with or by GEI. I agree that my Personal Information can be used by GEI in all forms and media for the purposes of advertisement and promotion. GEI may publish this information on its internet site, in its publications, and in all other forms and media for the purposes of advertising and promoting its work.

I release GEI, and its assigns, licensees and successors, from any claims that may arise regarding the use of my name and image, including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. I waive all rights to inspect or approve versions of my image and related Personal Information before its publication. I acknowledge that I am not entitled to any compensation for creation or use of the finished product.