Apply Kenya 2019 - Somewhere Devine

Personal Information

Full Legal Name: (as it appears on passport)*

First Middle Last

Nickname

First

Gender*

Marital Status*

Date of Birth:*

MM

DD

YYYY

Age (Must be 18 by Nov 17th, 2019):*

Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone Number:*

Email Address:*

Enter Email Confirm Email

Passport Number: (if you don’t have a passport yet, please leave this blank.)

Copy of Passport

Passport Expiration Date

MM

DD

YYYY

Emergency Contact Name & Relationship:*

Emergency Contact Phone:*

T-Shirt Size:*

Special Interests and Occupation:*

Facebook:

Instagram:*

MEDICAL HISTORY: Allergies? Currently taking medication? Other conditions we should be aware of?*

ROOMING REQUEST: "I prefer to room with..." (Don't worry if you don't know anyone else coming. We'll pair you with a new friend!)

Paypal Email Address*

Contract

Please read and sign the contract below.

The undersigned participants in the 2019 Somewhere Devine Expedition (the “Expedition”), hereby expressly acknowledge and agree to the following as a condition of my participation in the Expedition:

1. I acknowledge and agree that I am fully informed and aware of the conditions under which the expedition is to be taken and, with respect to Somewhere Devine (“Somewhere Devine”), I accept full responsibility and liability for my health and safety and assume all the risks inherent in participating in the Expedition. I understand and agree that responsibility for medical insurance and cost of healthcare during the Expedition is solely my own.

2. With full knowledge of the consequences, I hereby release Somewhere Devine, it agents, employees, officers and directors, from any and all liability of any nature with respect to my participation in the Expedition, and I waive any claims or causes of action which might arise against Somewhere Devine, its agents, employees, officers and directors, from my participation in the Expedition. This release shall be binding upon my heirs and any personal representatives of my estate.

3. I further understand and agree that Somewhere Devine is not responsible for any personal injury, damage to property, financial loss, delay in travel, or other injury, loss or expense that I may incur as a result of participating and traveling during the Expedition. I acknowledge that I travel and participate at my own risk. I release Somewhere Devine from any responsibility for personal injury, damage to property, financial loss or other injury or loss of any kind that I may incur as a result of my participation.

4. I hereby authorize Somewhere Devine to use without cost or payment to me, for its own business purposes, any pictures or images of me (regardless of media format) taken during the Expedition, and I release Somewhere Devine from any claims relating to its use of such images.

5. Participant is responsible to provide official background check to participate in Mattaw Children's Village Kenya.

6. Once the participant is accepted to the "Expedition", Somewhere Devine will issue no refunds.

Signature*

I have read and understand the foregoing release and waiver of liability form and hereby sign this agreement, intending to be legally bound thereby.

Payment Information : Application will not be processed until downpayment made via Paypal

Somewhere Devine requires a 50% NON-REFUNDABLE down payment to apply. Any funds received, whether deposit or payment, are considered NON-REFUNDABLE once received by Somewhere Devine. However, if for whatever reason your application is not accepted, Somewhere Devine will refund your deposit in full within one week. Somewhere Devine, in its sole discretion, reserves the right to limit participation in any trip for any reason whatsoever. After you click submit, you will be redirected to pay via Paypal.

KENYA 2019 EXPEDITION: 50% Non-Refundable Down Payment*

Price: $1,425.00