This application and waiver is for high school Jamaica trip June 15-20, 2020. These specific trips are for incoming high school freshmen through outgoing seniors in high school in the 2020- 2021 academic year. Price: $1800 *THIS PRICE DOES NOT INCLUDE AIRFARE. GROUP AIRFARE IS PAID FOR SEPARATELY THRU OUR GROUP TRAVEL AGENT. Airfare not due until March, 2020. Contact Travel Leaders Lori Link at 262-375-1990 Ext 401 for flight details and payment. There is a limited amount of group airfare so pricing is subject to change.
Before moving on please make sure to have the following information ready: 1. Only those over 18 can fill this waiver out. It is a legal document. 2. Medical information including primary care physician contact. 3. Emergency name and contact info. 4. Volunteer cell and email info. 5. Volunteer t-shirt size. 6. Insurance info. 7. Method of payment. 8. Passport information if you have it. If you have to update your current passport or apply for you you can still fill this registration/waiver out and submit it to wenzler@pivotaldirections at a later date.
As it appears on your passport
**Please note that if a student participant is 18 years of age or older, they must sign this form with their name- NOT their parent's name
-
Volunteer's date of birth
Grade level you are going into Fall of 2020
Passports cannot expire within 6 months of travel date. If the participant needs to obtain a passport they must make a copy and inform Pivotal Directions.
What is the volunteer's passport number?
When does the volunteer's passport expire?
Primary parent contact name
This email address will be used for all communications.
Please read before continuing. Pivotal Directions, Inc. and its Jamaican partners may not be equipped to handle all medical challenges. Facilities and terrain are not wheelchair accessible. Food outside of an established grocery store do not provide an ingredient list. Pivotal Directions, Inc. and its partners are not equipped to handle all allergies. We do not have staff with medical training to be responsible for serious conditions. Significant concerns may require a doctor's note or potentially prevent a volunteer from participating in the international trip. The volunteer may send a medical professional or guardian to assist the participant with their condition. If they choose not to send one of these people, they participate at their own risk. Pivotal Directions Inc. will cooperate with the participant to assist within reason lesser medical, non-life threatening conditions. Please do not continue with this registration and waiver until Pivotal Directions leadership, and/or a physician(s) have been consulted. Contact Jeff Wenzler at wenzler@pivotaldirections.org or 414-403-2279.
Please explain level of severity and treatment
List and explain any known disabilities or illnesses that might interfere with the volunteer's participation in activities (if applicable).
Are there any emotional/social disabilities or challenges that would be helpful for the leadership team to be aware of? This information will be kept discreet with the staff. It helps the trip leaders to communicate with the parent or volunteer prior to the trip any special circumstances or needs, such as the importance of their medications. All medications, unless physically handed to a leader with specific dosing schedule is not the responsibility of Pivotal Directions, Inc. and any of its volunteer leaders or partners. Participants who choose not to hand over medications are responsible for their own wellness. Are there emotional concerns that Pivotal Directions, Inc. should be made aware of? If you respond YES below, please privately contact wenzler@pivotaldirections.org or 414-403-2279 A note from a physician and/or private consultation with the participant's physician may be required before participation may be granted. Pivotal Directions, Inc., its adult volunteer leaders and partners may not be equipped to handle significant disorders and/or medically diagnosed conditions.
Please check all boxes that may apply to the volunteer (if applicable). Pivotal Directions reserves the right to request more information and permission from the participant's physician. If Pivotal Directions determines that it does not have appropriate capability to handle significant concerns safely the participant may be declined.
If a participant has a medical emergency or medical condition that arises during the trip that prevents them from participating in activities and they decide with the parent (or approved Emergency Contact in the absence of reaching the paren/guardian listed in the registration) and adult leadership's agreement that it is the best interest for the participant to return home they will do so at their own expense. In non-life threatening emergency situations, Pivotal Directions, Inc. will assist with the booking and payment of the transportation of the participant to an airport where an approved adult will pick them up. This cost must be reimbursed within 30 days. If it is determined that an adult should accompany the participant, the cost for travel to and from Kingston, Jamaica on the first available flight for the accompanying adult is the responsibility of the participant or their parent. This cost must be reimbursed to Pivotal Directions, Inc within 30 days.
List any medications, condition, dosage, side-effects, the volunteer is currently taking or any special diet or exercise restrictions (if applicable)
Sample list of activities on trips. Please check all the boxes stating you understand the type of activities the volunteers may participate in. Many of the activities we have participated in during past trips are located on the website. These activities involve, but are not limited to, the following: hiking, minor carpentry, cleaning, tutoring, sport recreation, swimming, cooking, travel on bus over one hour in duration, long days, hot or rainy weather, caring for children, elderly, and those with physical/mental disabilities. Contact trip director Jeff Wenzler at 414-403-2279 before completing this form with any questions.
Certain volunteer projects require gloves and durable shoes to protect for nails and cuts. It is the volunteer's responsibility to bring and wear this protective gear. This protective gear does not guarantee that the participant will stay safe from all foreign objects. Volunteers participate in projects by their free will and at any point reserve the right to not participate if they feel unsafe or uncomfortable.
It is HOT in Jamaica. The Pivotal Directions staff can only provide water to its participants and encourage participants to drink, however it cannot force them to drink.
I understand that due to the culture and process of preparing meals, Pivotal Directions, Inc. and its partners cannot provide an ingredient list. Students with dietary limitations will have to bring or purchase food at their own expense.
I understand that basic trip insurance is supplied by Pivotal Directions, Inc. to protect team members from extreme medical expenses due to illness or injury while participating in Pivotal Directions, Inc. and is included in the trip package cost. If additional insurance is desired, it is the responsibility of the participant’s parent to contact Pivotal Directions director to get contact information of the overseas’ insurance provider. This insurance is not for any trip interruption or cancelation.
I understand that I have been instructed to consult the child's primary care physician or international travel clinic with the recommendation of the Center for Disease Control for the areas that your child will travel in order to determine appropriate shots or vaccinations. For Jamaica volunteers, we spend most of our time in downtown Kingston, the landfill community of Riverton, and Spanish Town.
By checking these boxes the volunteer's parent is agreeing to our volunteer code of conduct that the all volunteers will sign agreement to.
I understand that Pivotal Directions does not allow the use of cell phones while in on its trips. This is a part of our unique experience. Participants utilizing cell phones for any purpose will be asked to turn them over. Participants will be allowed to utilize staff phone if an emergency arises. This should be discussed with the participant prior to departure.
Pivotal Directions cannot be of legal assistance if a volunteer breaks a law in Jamaica. Do not attempt to obtain or transport any illegal substance or item that you are not fully aware of. Being in the presence of illegal activity is enough to get the student in trouble with the local law and jeopardize the continuation on the trip with Pivotal Directions. Pivotal Directions cannot assist with a volunteer if they are in legal trouble in Jamaica. The parent of the participant may have to fly to Jamaica to handle any legal troubles or transport the participant home if the discontinuation of the trip is necessary. This will be at the expense of the participant.
For the safety of the group and because each volunteer is an ambassador of Pivotal Directions, Inc., Pivotal Directions leadership has the right to check any volunteer's bag at any point in the presence of another adult and the volunteer.
Due to the unfortunate high rate of teenage drug and alcohol use we would like the volunteer's parent to clearly understand that we have a ZERO TOLERANCE of drug and alcohol use in all of our programs, activities and trips. If there is a past history of drug or alcohol use with my child I will inspect their bags and discuss the code of conduct with them.
For the privacy, health and safety of everyone, no males are to be in female sleeping rooms or vice versa without consent by Pivotal Directions staff. I will discuss this with my child.
The pool at the convent where we stay has a platform high dive. The kids love it. We need your permission if they can utilize it.
One free day is an eco tour to the Reach Falls waterfall in Portland, Jamaica. This is a hike through the shallow river with rocks that contain various currents. There is a two-story waterfall that many visitors jump off of into a deep pool. There are also water caves that participants explore. We need your permission if the participant is under 18. Google "Reach Falls" videos or call Pivotal Directions with questions before signing.
Release to use image and likeness. Pivotal Directions, Inc. or its representatives takes photographs or makes an audio or videotape recording of students and/or adults involved in activities. Such photographs or video records may be used by staff and participants to remember the activities and participants. Local news organizations may hear of our activities or events, and our organization may invite or allow them to photograph or record our events for news reporting on special interest features. I consent to the use of any such audio or visual record of the student named above to be used, distributed, or displayed as agents of the organization see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings. Further- more, I give permission for the student to be interviewed by the news media, or for such photographs and other audio or visual records to be used by the news media. In addition, such photographs and audio/visual recordings may be used in publications or advertising materials to let others know about our activities. These images may also be used by Pivotal Directions, Inc. or its agents to produce resources for staff training, or other uses such as, but not limited to, our website www.pivotaldirections.org or the Pivotal Directions Facebook page, to promote Pivotal Directions, Inc. Pivotal Directions, Inc. may also make these materials available for sale to the public.
I understand that Pivotal Directions, Inc. is not responsible for any inclement weather or unforeseen conditions in a developing country. Plane tickets are in the name of the participant (and the sole property of the participant) and are subject to the rules of the airline if changed. Only in the case where the US State Department recommends that travelers should not travel to Jamaica, will the trip be canceled. Warnings about travel do not meet the criteria for not traveling. It is common for their to be warnings traveling to Jamaica as well as many other countries. If the group can travel to another destination (inside or outside of the United States or another part of Jamaica to volunteer Pivotal Directions will make those arrangements. Please understand this prior to agreeing below.
Any damage to property that is the result of my child (or their group participation in) will be my (the parent's) financial responsibility, or co-responsibility with another volunteer's parent, and agree to pay the damages.
I will inform my child that Pivotal Directions, Inc.'s cultural immersion in servant leadership programs are based upon a "voluntary participation by choice" philosophy. The volunteer agrees to let the Pivotal Directions trip leader know if they feel that a project or activity they are involved in is beyond their emotional or physical capabilities.
I understand that Pivotal Directions, Inc. is a non-profit organization serving the needs of the disadvantaged individuals, orphans or disabled persons in Jamaica and is not responsible for any cancellation, errors or omissions on the behalf of Pivotal Directions, Inc. or on behalf of the group or suppliers providing travel services as a result of this reservation. Nor is Pivotal Directions, Inc. responsible for weather, or unforeseen conditions in a developing country. I accept that Pivotal Directions, Inc. has the right to terminate the volunteer’s stay, at any time, at the student’s parent’s expense, if for any reason the student’s behavior, language, or action is offensive, or detrimental to "Pivotal Directions, Inc. and its members or those it serves. Cancellation: I understand that we have agreed that paying the trip deposit that my child's trip deposit of $400 is non-refundable. The deposit secures a spot only if space is available. It will be returned if no space is available. The non-refundable deposit pays for administrative fees and trip logistics and materials. The remaining balance of $1400 can be paid in full or in monthly installments. Late payments can forfeit the student’s spot on the trip and forfeit any monies received. Often times, a participant's reservation takes away from a another potential participant's spot. Entire balance is due 45 days prior to departure, unless agreed upon in writing with Pivotal Directions, Inc. leadership. Any donations or fundraising monies donated to Pivotal Directions, Inc. on behalf of the student or organization will remain with Pivotal Directions, Inc. to subsidize the loss of the paid reservation. Any group airline tickets purchased for the student participant on the Pivotal Directions, Inc. trip become the property of the student according to the travel agency or airline rules. Cancellation or transfer of the airline tickets are subject to the airline policies. If another "qualifying" student on a waiting list is able to replace the cancelling student participant (subject to transferring airline ticket policies) and less the non-refundable deposit may be permitted on a case by case basis. "Qualifying" student is defined as a participant who has met the requirements listed above and admitted in time to secure appropriate transportation and lodging. I hereby hold Pivotal Directions, Inc. free of any claims made as a result of the changes/cancellation of my trip registration.
Liability Release. Note that the designation of "undersigned" is on behalf of the minor attending said trip. IF the student/participant is 18 years of age or older they must sign themselves.
In consideration of the acceptance given the undersigned by Pivotal Directions, Inc., for participation in the Pivotal Directions, Inc. service trip to Kingston, Jamaica, during the dates stated at the beginning of this application, the undersigned, for good and valuable consideration heretofore mentioned, the receipt of which is hereby acknowledged, does by these present hereby forever release and discharge Pivotal Directions, Inc., their employers, employees, principals, volunteer leaders, agents, insurers, successors, and assigns, for and from any and all liability, claims, demands, controversies, damages, actions, and causes of action arising out of, or resulting from the undersigned’s participation in the above described activity or event, including but not limited to all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses arising out of, directly or indirectly, the aforementioned activity or event. The undersigned acknowledges the risks inherent in the aforesaid activity or event and hereby voluntarily and knowingly assumes those risks and acknowledges that, in releasing and waiving all claims, demands, actions, or causes of action heretofore mentioned, that undersigned does so on behalf of himself or herself, his or her heirs, executors, administrators, successors, and assigns. The undersigned represents that he or she fully understands the intent, meaning, and import of this agreement and has read the same prior to signing.The undersigned, by signing this agreement, authorizes the aforementioned parties to provide or furnish any necessary transportation, food, or lodging associated with this activity or event. Further, the participant does hereby acknowledge his or her status and capacity of that of a licensee only, with respect to any real property used or occupied in conjunction with the aforementioned activity or event and does also hereby release and discharge owner and occupier of said real property from any and all liability, claims, demands, controversies, damages, actions, and causes of action arising out of the use for occupation of said real property. The undersigned further hereby agrees to indemnify and save harmless the aforementioned parties, their employers, employees, principals, agents, insurers, successors, and assigns from any liability incurred by said parties resulting from the negligent, willful, wanton, or intentional acts of the undersigned. The undersigned hereby acknowledges the receipt of Code of Conduct promulgated and distributed by the parties and hereby agrees to abide by the same and further agrees to adhere to the directions of those in authority and leadership for the activity or event. By selecting the "I ACCEPT" button, you are signing this Liability Release electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Liability Release. By selecting "I ACCEPT" you consent to be legally bound by this Liability Release's terms and conditions.
What is your relationship to the volunteer?
Type full name of the Parent/Guardian/Adult Volunteer who is electronically signing the above information and liability release. You should have accepted/signed only the waiver for the trip your child is attending.
Total $1800 June 15-20, 2020 (this includes payment service charge) *not including flights and baggage. Balance is paid in monthly installments. Space is limited.
$400 non-refundable deposit to secure a spot. Payment information will be sent electronically upon receiving this waiver and registration.
Please secure flight with Travel Leaders Lori Link at 262-375-1990 Ext 401 llink@tldiscovery.com Do not wait to provide them your method of payment. Credit Card or Debit transaction will not occur until after March, 2020.
Please pick one of the options listed below.
Please enter the routing number for your checking account.
Please enter the account number for your checking account.
Please enter your credit card number.
The CVV Number ("Card Verification Value") on your credit card or debit card is a 3 digit number on VISA®, MasterCard® and Discover® branded credit and debit cards. On your American Express® branded credit or debit card it is a 4 digit numeric code.
Please enter the expiration date for your credit/debit card.
If you have any questions that prevented you from electronically submitting this form or need to expand upon any special needs of your child we should be aware of please contact Jeff Wenzler at 414-403-2279 or wenzler@pivotaldirections.org
**UPON SUBMISSION THE $400 TRIP DEPOSIT FEE WILL BE DEBITED FROM YOUR PAYMENT METHOD**
What trips or camps have you attended with us? Leave blank if none.
How did you hear about Pivotal?