Maui ToTCD Training Registration Form

Training of Transformational Community Development (TCD)

Maui 2023 Registration Form
Each participant (trainers and trainees) must complete this registration per person form prior to attending the training so we may have your contact info, emergency contact info, food allergies, and signed GHNI waiver.

Note: Please "Save" periodically in case you need to complete the form later.

Register before January 15, 2023 so we may plan accordingly.

Space is limited!

Training Location: Hope Chapel Kihei, Maui
300 E Welakahao Rd
Kihei, HI 96753

January 30-February 1
Sessions are 7:30AM - 8:00PM daily

COSTS

Accommodations: Hosted by Hope Chapel members in their homes and we request you gift your host $10/day in appreciation.

Training Fee: All Meals (B/L/D) and Training Supplies included
ToTCD Training (3 days) $200

Payment: Please make checks payable to "Hope Chapel" and note "TCD missions training” on the memo line. Mail check to Hope Chapel’s address above.

OR

Credit Card Payment: Hope Chapel can take credit card payments over the phone by calling Emily at (808) 913-0722.

Non-Maui Residents: Fly into OGG, Kahului, Maui, HI by January 29th and depart Feb 2nd. Send your itineraries to Dr. Heidi Wu at heidiwumd@yahoo.com.
Scholarship/ Financial Assistance Requested:

YesNo
Accommodations Needed:*

YesNo
Ground Transportation Needed:*

YesNo
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

MaleFemale
Phone Contact*
E-mail*
Do you have any food allergies or preference we should be aware of?
(We may not be able to accommodate all preferences.)
Please list any questions or comments here:

Medical Information

Health Coverage
Please advise of any medical condition that may limit your activities during the training.
Health Insurance Provider*
Policy Holder*
Policy Number*
Group Number*
Provider Phone Number*
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Phone #*
Email*
example@example.com
Relationship to you*

Field Training Security Agreement & Liability Waiver
Field Training Security Agreement

As a participant in field training on humanitarian aid with GHNI, I, the undersigned, agree to the following:

I agree to abide by any and all legal instruction given by the GHNI representative or team leader. Such instructions will include but may not be limited to the following;

To abide by the instruction of the GHNI representatives or team leaders, in regard to the taking of visual images or sound recordings or publications that may compromise security or cultural sensitivity.
To abide by the instruction of the GHNI representatives or team leaders, in regard to matters of safety, security, dress and conduct.
Adhere to any instruction regarding the publication and syndication, of photographic or digital images, stories, names, etc, obtained as a result of your participation of this training.
To not publicly implicate any action of GHNI is for the express purpose of political or religious ambitions.
To not making any statement on behalf of GHNI without the written expressed permission of GHNI.

Liability Agreement

The undersigned wishes to participate in a field training (herein the “Activity”) with Global Hope Network International (GHNI), a non-profit corporation.

GLOBAL HOPE NETWORK INTERNATIONAL and the undersigned agree that the Activity poses risks including the following specific risks: sickness, crime, political instability, governmental opposition to project activities, as well as similar and dissimilar risks (herein the “Risks”).

For and in consideration of GLOBAL HOPE NETWORK INTERNATIONAL assisting the participant in the Activity, and other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the undersigned for himself/herself and his/her personal representatives, assigns, heirs, distributees, guardians and next of kin (herein the “Releasors”), hereby irrevocably and unconditionally releases, waives, discharges and covenants not to sue GLOBAL HOPE NETWORK INTERNATIONAL and its affiliates, subsidiaries, divisions, members, directors, officers, employees and agents (herein the “Releasees”), for and from all claims of any nature now or hereafter existing whether known or unknown, including but not limited to, all liability to the Releasors, on account of injury to the undersigned or death to the undersigned or injury to the property of the undersigned, whether caused by the negligence of Releasees or otherwise, while the undersigned is participating in the Activity.

The undersigned is fully aware of the Risks and other hazards inherent in the Activity, and voluntarily assumes the Risks and all other risks of loss, damage, or injury that may be sustained by the undersigned while participating in the Activity.

The undersigned further agrees that he/she bears the sole responsibility for any and all medical expenses which he/she incurs while participating in the Activity, whether for injury or illness, and whether required as a result of the undersigned’s participation in the Activity or not. The undersigned acknowledges Releasees are under no obligation to, and do not, provide medical insurance for the undersigned.

The undersigned warrants that he or she has fully read and understands this Liability Release Agreement and voluntarily signs the same, and that no oral representations, statements or inducements apart from the foregoing written agreement have been made to the undersigned.

The Sending Agency for this project is:

Global Hope Network International
A Swiss relief organization headquartered at
Rue de Varembé 1,
1202 Genéve, Switzerland

Telephone: +41 (0) 22 733 1542 Email: globalops.hr@ghni.org

I acknowledge and agree to be under the authority of GHNI (Geneva), a Swiss relief organization. During my time of volunteering with this organization I understand they will be responsible for overseeing my work in the country I participate with GHNI. All personnel matters will be deferred to this agency. I understand that reporting responsibility and control rests with GHNI, a Swiss organization, throughout the duration of my participation.

BY MY SIGNATURE BELOW, I AM INDICATING THAT I HAVE READ, UNDERSTOOD AND AGREE TO ACT IN ACCORDANCE WITH ALL OF THE CONDITIONS EXPRESSED ABOVE.
Your support is greatly appreciated!
Thank you for seeking to participate in our training!
Signature*

Clear
Date of Signature*

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Once your registration has been successfully submitted, you will receive a confirmation email. If it is not sucessful, please submit again.
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Training of Transformational Community Development (TCD)

Medical Information

Emergency Contact Information

Field Training Security Agreement & Liability Waiver