Volunteer Information Form

To help us create a SAFE and enjoyable holiday experience for you, the following form must be completed and SUBMITTED ONCE flights have been booked.

Name

First Name

Last Name

Date of birth

YYYY

PASSPORT NUMBER

PASSPORT EXPIRY DATE

*Please ensure your passport has at least 6 months validity from departure date.

Please select the Holiday you will be attending

PAYMENT

Emergency contact:

First Name

Last Name

Phone

Country

(###)

###

####

ARRIVAL FLIGHT NUMBER

ARRIVAL DATE

ARRIVAL TIME

Hour

Minute

Second

DEPARTURE FLIGHT NUMBER

DEPARTURE DATE

DEPARTURE TIME

Hour

Minute

Second

ADDITIONAL NIGHTS ACCOMMODATION

I require my room for additional nights

I do not require additional nights accommodation

Additional dates required:

ALLERGIES

DIETARY REQUIREMENTS

RELEVANT MEDICAL INFORMATION

Any injuries/ ailments/ disabilities which may prevent you taking part in activities including a cycle tour, yoga, physical building:

ADDITIONAL FUNDING / DONATIONS

NB/ Head, Heart and Hand Holiday volunteers offer contribution in the form of 3 days voluntary building work. Each volunteer is required to raise AUD $250 in contribution to the Wash House Project (unless sponsored.) 75% of the Head, Heart and Hand package price goes directly to support our team and projects in Cambodia. Additional donations in the form of tooth brushes/ tooth paste or funding for on-going toiletry supplies and hygiene education are always gratefully accepted. Nb/ as of 2020 Wash House funding will be included in each package price.

DECLARATION

I have read and agree to adhere to the CODE OF CONDUCT (available on the website)

I understand that I am responsible for obtaining travel insurance that includes volunteering and emergency evacuation.

I understand that I am attending a Head, Heart & Hand Holiday at my own risk and Head, Heart & Hand Holidays will not be held responsible or liable for death/ injury/illness or loss of personal items incurred on a Head, Heart & Hand Holiday.

I understand and agree that volunteering with Head, Heart and Hand Holidays is subject to the agreement of both individual parties and must fall within the guidelines of the Head, Heart and Hand code of conduct and child protection policy.

I understand that as part of the Head, Heart and Hand Holiday experience I will be involved in daily personal development sessions (tribe)

I have read the PERSONAL DEVELOPMENT section (available on the website) and have an understanding of the expected results.

PERSONAL INTENTION

In order for you to get the most out of your Head, Heart & Hand Holiday experience and for us to get to know you a little better - please briefly share with us your personal intention (Eg. what you hope to gain from the personal development aspect of the holiday inclusive of your overall holiday experience.)