First Name | Last Name *

Please provide your full name as it appears on your passport

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone Number *

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BASIC MEDICAL INFORMATION *

While a complete physical is not required for participation in this trip, it is encouraged. It is our hope and your responsibility to ensure your own physical condition is satisfactory for participation in this trip.

I understand that it is solely my responsibility to complete a physical exam and or ensure that my physical condition is satisfactory for participation in this type of work.

I understand that it is solely my responsible to receive all necessary vaccinations required for my trip as communicated to me by AsOne or my Trip Leader.

ASSUMPTION OF RISK *

Part of international travel includes the risk of contracting diseases prevalent in foreign countries, as well as current pandemic illnesses. For travel to Uganda this includes but is not limited to: COVID-19, Ebola, Malaria, Polio, Typhoid, etc. Therefore, by submitting this application you agree to: (check all that apply)

(1) Comply with AsOne's and my trip leader's travel and in-country precautionary policies related to local illnesses.

(2) I agree to allow AsOne to make the best decision(s) for my trip for the health and safety of all involved due to ongoing pandemics. I understand any cancellations or changes to my trip due to these illnesses will not result in any full or partial refund of my trip. Instead my balance will be reserved by AsOne for a Scholarship in my name for a future Immersion Trip.

(3) I agree to release AsOne Ministries from all liability of contracting COVID-19, Ebola, or otherwise while on my Immersion Trip, understanding that it is an inherent risk of international travel.

AGREEMENTS & OBLIGATIONS: *

BY SUBMITTING THIS APPLICATION:

I understand that upon review & acceptance, I am responsible for my airfare and trip cost as communicated to me by AsOne Ministries as well as obtaining a passport and necessary immunizations, completing a waiver release form, providing up-to-date immunization records, and adhering to AsOne's deadlines.

I understand that by submitting this application it does not guarantee my participation in a trip. In order to fully participate I must be accepted by AsOne and the Trip Leader, pay my deposit and full trip balance, attend all preparatory meetings, and ensure I have all the necessary documentation to travel.

I understand that, if I do not raise and submit the necessary funds by the final due date, my flight will be canceled and I will not be able to participate in the program.

I understand that, should I need to withdraw from this trip for any reason, I am still responsible for any expenses that have already been incurred on my behalf by the date of my withdrawal and that, because funds can not be returned for any reason, any remaining funds that were donated on my behalf will be disbursed to other trip participants and/or programs at the discretion of AsOne Ministries within AsOne's current fiscal year.

I understand that all donations that are given to AsOne by me or on my behalf, including my deposit, can NOT be returned in any form for any reason. In the event that I raise more than is necessary to fully cover the cost of my own trip, funds will be dispersed to other trip participants and/or programs at the discretion of AsOne Ministries within AsOne's current fiscal year.

I understand that the insurance policy purchased with the plane ticket is the Pro Plus Plan through Roam Right.

I have reviewed the insurance options & policy details via the 'Insurance' link found on the 'Immersion Resources' page on our website.

I understand that if future changes must be made to my plane ticket due to inaccurate information I have provided on this application or due to withdrawal from the trip for any reasons - will be my financial responsibility.

I confirm that I am filling this application out for myself, not for someone else. AND THAT all information I have provided on this form is correct to the best of my knowledge and matches my passport.