Volunteer Form

Name:

Date of Birth :

*18 years old minimum.

Nationality:

Please contact the Indonesian embassy for information on the Visas. Procedures can be different for different nationalities.

Passport Number:

Date of issue:

Expiring on:

Passport has to be still valid for a minimum of  6 months after the end of the travel to Indonesia

Permanent Address :

Approximate date of departure from your country of residence:

Approximate date of return to you country of residence:

Stay can be from 2 weeks to 2 months depending on the Visa you obtain at the Indonesian Embassy of you country. Visa on arrival are just for 30 days

Date of departure and arrival has to be reconfirmed before departure

Contribution to Kalaweit (include logistic, local transport, food during the stay)

1 Week: 110 Euros

___________    X        110         =__________Euros

 Nb of weeks

1*These fees don’t include: International Flight to Jakarta ; Local flight from Jakarta to Palangka Raya ; Transit one night in Jakarta (Hotel, Taxi from the airport to the hotel in Jakarta),  Souvenirs, extra, etc.

2*Donation have to be paid before the departure.

3*You will receive confirmation for the Kalaweit Office in France

4* 2 to 7 days are considered like 1 week. Example: Stays of  9 days at Kalaweit have to be considered like 2 weeks.

Volunteer should have an assurance in case of accident:

Signature:____________________

Ps: Please send back this form (with 1 identity photo, 1 copy of your passport, and 1 declaration that states that Kalaweit is not responsible in case of accident –you can download it on our website-) to the UK Kalaweit Coordinator.

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Disclaimer/Waiver

I, the eco-volunteer:

Residing at

Have read and understood all the terms and conditions of the organisation pertaining to the Eco-volunteer expedition organised by the Kalaweit Association and I accept these without reserve.

Date of birth :

Telephone:

Email:

Anti-malarial treatment prescribed: 

Travel Insurance Company Details (including contract number):

Medical Insurance Company Details (including contract number) Medical insurance MUST include repatriation cover:

Reminder : You must provide the Kalaweit Association with a written statement that you have travel and medical insurance (including repatriation cover). Photocopies are acceptable.

I have been informed of the risks of traveling by a medical centre before the start of my trip and I discharge the Kalaweit Association from any responsibility in should I require any medical assistance or repatriation.

This here indicates I discharge responsibility, is legally valid and binds the above named person and all members of my family. 

Singed the  ………………   2004

Signature: