• Rafiki Trip Application

    * Please submit completed application, $50 fee and passport photo ID* Each traveler needs to submit an application*
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  • In Case of an Emergency, Notify

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    Insurance Company _________________________Policy & Group Number: ___________________
    Phone Number _____________________Name of Beneficiary: _______________________________
    Name of Your Physician: _________________________________         

  • I acknowledge that participation in the above trip involves risk to the Participant (and to Participant’s parents or guardians if Participant is a minor), and may result in various types of injury. In consideration for the opportunity to participate in the above trip, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in the trip. I understand that Rafiki Africa, its agents, employees, volunteers, or any other representatives (collectively included hereinafter in the term “Trip Sponsor”) assume no liability for any personal harm or illness or for loss or damage of any property that may come to me while serving as a mission volunteer, and I, my heirs, and my personal representatives and assigns, hereby absolve the Trip Sponsor and hold them harmless from any claim or demand that I, my heirs, my personal representatives or assigns might conceivably assert for any such harm, illness, loss or damage. I confirm that the information provided by me on this application is correct. I understand Trip Sponsor may use any images or videos I take while on the mission. I approve the sharing of my contact information with others participating on this trip. I also purpose to partake in required pre and post mission training. I intend to be legally bound by this statement.

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