Application form - Sierra Leone Mastermind

Full Legal Name

First NameLast Name

Preferred Name

Date of Birth

MonthDayYear

Residency Status (Canadian or Permanent Resident or Other)

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Mobile Phone

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Do you currently hold a valid passport?

Passport Number

Passport Expiry Date

Date

Upload passport photo page

Primary Contact Full Name

First NameLast Name

Primary Contact Relationship to You

Primary Contact Mobile Phone

Please enter a valid phone number.Format: (000) 000-0000.

Primary Contact Email

example@example.com

Secondary Contact Full Name

First NameLast Name

Secondary Contact Relationship to You

Secondary Contact Mobile Phone

Please enter a valid phone number.Format: (000) 000-0000.

This information is kept strictly confidential and used solely to ensure your safety on the trip.

Are you in good general health and fit for international travel?

If yes, please describe your condition and any accommodations needed

Have you consulted or are you willing to consult a travel health clinic prior to departure?

Are you willing to receive recommended vaccinations for Sierra Leone?

Are you currently taking any prescription medications?

If yes, list all medications and dosages

Do you have any serious allergies?

If yes, describe your allergies and note any EpiPen or emergency medication

Do you have any dietary restrictions?

If yes, specify dietary restrictions

Do you have travel/extended health insurance?

Insurance Provider / Company Name

Policy Number

Policyholder Name

Name as it appears on the policy

Coverage Start Date

Date

Coverage End Date

Date

Emergency Assistance Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Maximum Coverage Amount in CAD

e.g. $1,000,000

Does your policy include emergency medical evacuation coverage?

The total trip cost is $7,990 CAD per person. Your spot is secured upon receipt of your first payment. Payment Plan: 6 monthly payments of $1,140 from May to October 2026, plus a final payment of $1,150 in November 2026. Total: $7,990. Payments are accepted via e-transfer to tara@freedomtree.ca.

Payment Preference

I understand and acknowledge that it is my sole responsibility to obtain all recommended vaccinations and travel prophylaxis for travel to Sierra Leone (including but not limited to yellow fever, typhoid, hepatitis A and B, and malaria prophylaxis) at my own expense, and to consult with a certified travel health clinic prior to departure. I understand that Freedom Tree and Wealth Genius are not responsible for arranging, providing, or covering the cost of any vaccinations or medications required for this trip.

I understand that travel to Sierra Leone involves health risks including tropical illnesses, and that medical facilities may differ significantly from Canada.

I confirm I am in good general health and physically fit for international travel.

I will obtain valid travel health insurance and provide proof prior to departure.

I understand the trip involves a tropical climate, shared accommodations, and conditions that may differ from Canada and I am prepared.

I will follow all behavioural, health, and safety guidelines set by Freedom Tree and the trip leadership team.

I understand and acknowledge that all payments I make toward this trip are charitable donations to Freedom Tree and are non-refundable. If I am unable to attend the trip for any reason, my contributions will remain with Freedom Tree and be directed toward the Project Youth Leadership initiative and Freedom Tree's ongoing charitable work in Sierra Leone. I will not be entitled to any refund.

I understand and acknowledge that all payments I make toward this trip are charitable donations to Freedom Tree and are non-refundable. If I am unable to attend the trip for any reason, my contributions will remain with Freedom Tree and be directed toward the Project Youth Leadership initiative and Freedom Tree's ongoing charitable work in Sierra Leone. I will not be entitled to any refund. Your generosity continues to make an impact whether or not you are able to travel

I understand my spot is not confirmed until my form is complete and my first payment is received.

I understand that failure to make payments on schedule may result in forfeiture of my spot.

WAIVER OF LIABILITY & PARTICIPANT AGREEMENT Please read carefully. This is a legally binding document. Parties: This Agreement is entered into between the Participant (you) and Freedom Tree (Registered Canadian Charity No. 839381688), Wealth Genius, and their respective officers, directors, employees, agents, volunteers, partners, and successors (collectively the 'Organizers') in relation to the Project Youth Leadership Delegation, Sierra Leone, January 2027 (the 'Trip'). 1. Voluntary Participation: I confirm that my participation in the Trip is entirely voluntary. I have not been coerced or misled. I understand the nature of the Trip and freely choose to participate. 2. Assumption of Risk: I acknowledge that international travel to Sierra Leone involves inherent risks, including but not limited to: illness, disease, or infection (including tropical diseases such as malaria, typhoid, and cholera, for which vaccines may not provide complete protection); personal injury, disability, or death; political instability, civil unrest, terrorism, or criminal activity; natural disasters or environmental hazards; inadequate or unavailable medical facilities; loss, theft, or damage to personal property; and delays or itinerary changes beyond the Organizers' control. I represent that I am in good general health and fit for international travel. I take full personal responsibility for obtaining medical clearance, vaccinations, and prophylaxis for travel to Sierra Leone. 3. Release of Liability: In consideration of being permitted to participate in the Trip, I hereby irrevocably release, waive, discharge, and covenant not to sue the Organizers from any and all claims, demands, losses, damages, actions, or causes of action — known or unknown, foreseen or unforeseen — arising out of or connected with my participation in the Trip, including claims arising from the negligence of the Organizers. This release applies to claims for personal injury, illness, disability, psychological harm, death, property damage, financial loss, and any other harm of any kind, whether arising before, during, or after the Trip, including in transit. I acknowledge I am not covered under any insurance policy held by the Organizers and am solely responsible for obtaining adequate personal travel health insurance. 4. Indemnification: I agree to indemnify, defend, and hold harmless the Organizers from and against any and all third-party claims, losses, damages, liabilities, costs, and expenses (including reasonable legal fees) arising from: (a) my breach of this Agreement; (b) my negligence or wilful misconduct; or (c) any claim brought by my dependants, heirs, or estate. 5. Medical Authorization: In a medical emergency where I am unable to provide consent, I authorize the Organizers and their designated representatives to consent to emergency medical treatment on my behalf. The Organizers are not liable for any treatment so authorized, and all costs of such treatment are solely my responsibility. 6. Code of Conduct: I agree to comply at all times with all behavioural, health, and safety guidelines established by the Organizers. The Organizers reserve the right, in their sole discretion, to remove me from the Trip at any time. In such circumstances, I am responsible for all costs of return travel and no refund will be provided. 7. Media Release: I consent to the Organizers photographing, filming, and recording me during the Trip and to using such materials for promotional, educational, fundraising, and charitable purposes across all media without compensation. I waive any right to inspect or approve such materials prior to use. 8. Governing Law: This Agreement is governed by the laws of the Province of Alberta, Canada. Any dispute is subject to the exclusive jurisdiction of the courts of Alberta. If any provision is unenforceable, the remaining provisions remain in full force. 9. Entire Agreement: This Agreement constitutes the entire agreement between me and the Organizers and supersedes all prior communications. I expressly waive any defence based on lack of consideration. This Agreement is binding on me, my family, heirs, and estate.

I have read the entire Waiver of Liability above and I agree to be bound by all of its terms.

Signature - Sign Here

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Type Your Full Legal Name

Date Signed

Date

City and Province

Project Youth Leadership: Sierra Leone 2027 — Registration

Passport Information

Emergency Contact — Primary

Emergency Contact — Secondary

Health & Travel Fitness

Payment Preference

Acknowledgements

Waiver of Liability and Electronic Signature