EMI Kili Climb
Climber Information & Commitment Form
Thanks for your commitment to the EMI Kili Charity Climb! Please email this form completed and signed to
JohnB@emiea.org.
VOLUNTEER PERSONAL INFORMATION:
FIRST NAME:
LAST NAME:
(M/F)
STREET:
CITY:
STATE:
ZIP:
COUNTRY:
EMAIL:
PHONE:
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(SELECT)
BIRTHDATE (MM/DD/YYYY):
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(SELECT)
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NEAREST MAJOR AIRPORT:
PASSPORT #:
PASSPORT EXPIRATION DATE:
T-Shirt Size:
EMERGENCY CONTACT INFORMATION
NAME:
STREET:
CITY:
STATE:
EMAIL:
PHONE:
(
)
-
(SELECT)
ZIP:
Requirements: I commit to…
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Fulfill all logistical requirements. I will comply with all requirements regarding passports, health insurance,
finances, shots, etc.
Fulfill the physical requirements. I will prepare for the physical endurance and stamina required for
extreme altitude climbing with a regimented exercise plan.
Provide for my own funds for the cost of the climb and for travel (unless subsidized by EMI through
fundraising incentives).
Fundraise in support of EMI East Africa and the Build Africa Together Campaign. I commit to raising a
minimum of $2000 whether through donations or my own contribution and will prayerfully consider any
additional personal fundraising goal.
Assumption of Risk / Liability Waiver
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I assume that there exist certain risks involved in this travel experience, both known and unknown. Risks
that include, but are not limited to, loss or damage to personal property, injury, and death due to
unforeseeable events.
I recognize the nature of the destination country and the extreme physical activity dictates that not all
dangers, hazards and perils can be foreseen or avoided.
I respect the team leader’s decisions and accept responsibility to learn and follow all safety standards,
guidelines, and procedures established by the leader.
I authorize EMI or any agent of EMI to act on my behalf should I be unable to do so and to consent to any
reasonable medical care.
I the undersigned acknowledge that I have read and understood the above travel agreement and am willing to
comply with every aspect of it.
Furthermore, by signing this agreement I, heirs, assigns, and relatives, on my behalf, hereby waive, release,
covenant not to sue and forever discharge, to the fullest extent permitted by law, EMI (Engineering Ministries
International) and its related or connected organizations, officers, agents, employees, representatives, successors,
assigns and all others of and from any and all responsibilities, claims, expenses, personal injury, wrongful death or
liability for injuries or damages of any kind whether caused by the negligence of EMI, or otherwise. The parties
agree that the interpretation of this agreement will be governed by Colorado Law.
______________________________________
Name (Please Print)
______________________________________
Signature
______________________________________
Date
Please email this form, once completed and signed, to JohnB@emiea.org.