TEACHING BEYOND BORDERS
A Daytona State College Service-Learning Initiative
NICARAGUA 2016
Summer A 2016
Student Information and Application
Welcome
Dear Daytona State College Student,
We are very pleased you have expressed interest in joining us for the Summer 2016
Insight Adventure to Salinas de Nahualapa, Nicaragua. This is not your average study abroad
program (SAP) and will most likely be a very meaningful and life-changing experience. The
purpose of the Teaching Beyond Borders (TBB) program is to teach students beyond the
conventional classroom by giving them meaningful service-learning experiences abroad. This
study abroad program is open to all Daytona State students. Participating students do not need
to be enrolled in the College of Education.
Please read the entire information packet before submitting your application.
Included you will find documents required by Daytona State College and our partners in the
field. Please complete these documents by typing your answers in the application. Print the
application (pages 13-20) and sign where indicated. Return your application in hard-copy form
to Dr. May at your earliest convenience. Your application will then be reviewed. Once you are
approved you will be given a clearance code to begin submitting payments for this SAP. You
will also be cleared to register for the SAP 3-credit course EDG2905 Directed Study in
Education.
Space is limited, so it is very important your application be complete, submitted in a
timely manner, and you complete payments as scheduled. Acceptance in the Teaching Beyond
Borders program is based on student’s demonstration of commitment to education and
community service. Applications will be processed in the order they are received.
Please see Dr. Donald May (200/308) and/or Margie Hensler (200/306) if you have any
questions regarding the TBB program or the information in this packet. Thank you again, for
expressing willingness to join our endeavors in Nicaragua.
Sincerely,
The Teaching Beyond Borders Team
Daytona State College
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TABLE OF CONTENTS
Study Abroad Program Information
Overview of Nicaragua Insight Adventure ………………………………………………….
Purpose of Teaching Beyond Borders …………………………………………………………
The Values of the Teaching Beyond Border Program ………………………………....
EDG 2905 Course Explanation……………………………..………………………………………
Requirements for Acceptance to the Program ……………………………………………
Schedule for Submitting Application and Payments ……………………………………
Estimated Student Costs …………………………………………………………………………….
Accommodations and Meals ………………………………………………………………………
Personal Care ……………………………………………………………………………………………..
Traveling Protocol ………………………………………………………………………………………
Health Information …………………………………………………………………………………….
Clothing ………………………………………………………………………………………………………
Packing for Your Trip …………………………………………………………………………………..
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Student Application Documents
Student Application (type in text fields, print and sign) …………………………………
Daytona State College Release Form …………………………………………………………….
Fundación Aprender Equilibrio Release Form ………………………………………………..
Teacher Recommendation Form ……………………………………………………………………
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(Select and/or print the last page only for teacher recommendation)
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Overview of Nicaragua Insight Adventure Project
The mission of Teaching Beyond Borders (TBB) is to teach DSC students beyond the
conventional classroom by giving them meaningful service-learning experiences abroad. The
Nicaragua Insight Adventure is part of an annual service-learning in education course offered
each Summer term. It is the intention of this program to create recurring service-learning
excursions to Nicaragua in which DSC students and faculty implement a project to support and
strengthen community development. After the trip to Nicaragua, students will create
presentations to communicate their experiences to stakeholders and sponsors and share the
current needs that could be addressed the following year.
DSC students will benefit by being immersed in the language (Spanish) and culture of the
Salinas de Nahualapa community, located near the west coast Popoyo region of Nicaragua.
Students will gain insight by seeking to understand the challenges faced by the indigenous
people and share their insights by developing and implementing a project to serve the
community.
Teaching Beyond Borders has partnered with The Fundación Aprender (Learning Foundation),
which is a non-profit organization committed to providing educational opportunities for the
youth in rural Nicaragua (http://www.aprendernicaragua.org/whoweare.html ). The leaders of
the foundation, James Womack and Gabriela Prado, have worked over 12 years to build strong
connections and relationships within the community. Because of these well-established
relationships, DSC students will have a myriad of choices for community projects and insight
excursions.
DSC students will spend the first four weeks of the SAP in the classroom at Daytona State
College learning conversational Spanish, discussing the community asset evaluation conducted
in the region, and designing a project to implement in conjunction with The Fundación
Aprender staff. DSC students will then choose an area of focus and work in small groups to
design projects to meet the needs identified by the community and Fundación Aprender staff.
DSC students will also be instructed in the basics of how to teach English language learners and
develop mini-lessons and activities they can implement in the region. DSC students will also
prepare during these introductory weeks by learning the cultural norms and general
characteristics of the region and inhabitants, and relevant historical factors.
Then students will travel to Nicaragua and spend approximately seven days in Salinas de
Nahualapa. Once DSC students are in Salinas, part of each day will be devoted to implementing
their projects and interacting with the residents of the local indigenous community. The other
half of the day structured excursions will be conducted (as time allows) because it is important
for the DSC students to see many diverse aspects of the Nicaraguan culture and extraordinary
ecosystem. For instance, students may have an opportunity to go turtle watching, visit local
farms, tour the Mombacho Volcano, and Colonial City Granada, and participate in Zipline
adventures, ocean boat trips, and remote beach picnics.
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In the final week of the SAP, DSC students will return to the classroom for debriefing and
finalizing their multimedia projects. These multimedia projects will be designed to
communicate their personal experiences and educational growth during the service-learning
project and will be presented to stakeholders, sponsors, and the greater DSC community during
a culminating symposium.
The experience of study abroad travel, in general, always has an effect on students as they are
able to broaden their viewpoint by seeing another part of their world. However, being able to
contribute and make a difference during those same travels will create a lasting memory that
will most likely shape your outlook and positively impact your career development.
Purpose of Teaching Beyond Borders Program
The foundational belief of Teaching Beyond Borders is that education is the most powerful
force we can use to change our world. This belief drives us in the Teaching Beyond Borders
(TBB) program to diligently work to increase access to a quality education for all children,
especially those children who live in impoverished regions of the world like Nicaragua.
Nicaragua is among the poorest countries in the Americas. According to the United Nations
Development Programme, 48% of the population of Nicaragua live below the poverty line
making less than the equivalent of $1,830 USD per year. Approximately 80% of the population
live with less than $2 per day. According to UN figures, 80% of the indigenous people (who
make up 5% of the population) live on less than $1 per day.
TBB seeks to change these trends by collaborating with community members in Salinas. An
effective program must be holistic in its approach if we are to make a difference in the lives of
children, promote education, and further community development. Sometimes our efforts may
be focused on supporting and training teachers, teaching English, teaching health and hygiene,
creating community gardens, supplying safe water, or offering micro-enterprise opportunities
to willing workers. In most cases our efforts go beyond working in the classrooms and schools.
The Values of Teaching Beyond Borders Program
To carry out its mission the Teaching Beyond Borders program has established the following
values:
 Empower people through education
 Create sustainable cross-cultural connections
 Promote and strengthen community development
 Provide increased access to a quality education
 Embrace diversity and emphasize all students can learn
 Promote literacy for the whole community
 Embrace excellence and foster innovation
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In our work to serve those who live in impoverished regions around the world, we subscribe to
the following oath created by Robert Lupton:
The Oath for Compassionate Service
 Never do for the poor what they have (or could have) the capacity to do for themselves.
 Limit one-way giving to emergency situations.
 Strive to empower the poor through education, employment, lending, and investing,
using grants sparingly to reinforce achievements.
 Subordinate self-interests to the needs of those being served.
 Listen closely to those you seek to help, especially to what is not being said – unspoken
feelings may contain essential clues to effective service.
 Above all, do no harm.
EDG 2905 Course Explanation
Directed Study in Education (EDG2905) is a summer term course open to all DSC students. This
course contributes to the student’s understanding of diverse populations, as well as to prepare
pre-service teachers to become culturally responsive teachers. The 3-credit course will help
satisfy the graduation elective requirements of the Associate of Arts (AA) degree. Students will
be required to complete a final multi-media project, which communicates their learning
experiences and the conclusion of the needs assessment conducted in the field, and present
their completed projects at a symposium event.
Requirements for Acceptance to the Program
Students must have a cumulative GPA of 2.0 or higher and have teacher recommendation to be
considered for the study abroad program. Students must also obtain a valid passport and
consult a medical doctor regarding preventive health measures (see Health Information below).
Priority will be given to students who are near graduation and have demonstrated consistent
dedication to academics and community service.
Schedule for Submitting Application and Payments
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October 1, 2015 – applications disbursed
October 5, 2015 – information session
October 29, 2015 – Study Abroad Symposium; information session 2
October 30, 2015 – applications due
November 6, 2015 – students will be informed of acceptance to the program
November 16, 2015 – $250 payment 1 due
November 30, 2015 – $250 payment 2 due
December 15, 2015 – $250 payment 3 due
January 15, 2016 – $250 payment 4 due
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January 29, 2016 – $250 payment 5 due
February 12, 2016 – $250 payment 6 due
February 29, 2016 – $250 payment 7 due (must reach total payment of $1750 by this
date)
March 7, 2016 - must provide evidence of valid passport; no refunds given after this
date
April 2016 – register and pay for EDG 2905 class
Students may complete payments earlier or pay in lump sum. All Study Abroad Program
payments are refundable prior to March 7, 2016. After March 7, 2016 no refunds will be
provided.
Securing Your Place in the Program
To be considered for the program you must submit a completed application with signature by
October 30, 2015. You will then secure your place in the program by submitting your first
payment to DSC Student Accounts in bldg. 100. Space is limited for this program. Therefore,
the first ten students who submit their application and deposit will be considered for
placement in the program. Up to five additional students may be placed on a waiting list. All
students, including those on the waiting list, must make payments as scheduled. Students who
do not make scheduled payments will lose their position in line. Students who are on waiting
list and who do not get placed in the program will receive a full refund.
Estimated Student Costs
Costs based on a minimum of 8 student participants.
Item
Transportation
Type
Airfare
USA
Ground
Nicaragua
Ground
Accommodations Equilibrio
Travel Insurance
Description
Round trip from Orlando, FL to Managua,
Nicaragua
Round Trip to and from MCO Airport
Round trip, Managua Airport to Equilibrio is
included in accommodations fee below
Accommodations based on double or triple
occupancy. Includes breakfast, lunch, and dinner
each day.
Provided by DSC (covers emergency evacuation)
*Total Cost per Student
Cost
~$825
~$58
-0~$867
-0$1,750
Not Included In Trip Costs
The following items are not included in the payments made to DSC Student Accounts:
 Tuition for course
 Costs of obtaining passport
 Excess baggage fees over allotted 50 lbs. (allot ~$50 or more for each additional checked
baggage)
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$10 Nicaraguan entrance / tourist fee (is collected by immigration)
Meals (lunch and dinner) and gratuities when not at Equilibrio (allot ~$100 or more)
Fees for additional excursions not provided by Equilibrio staff, surfboard rental, etc.
Any medical costs incurred in-country
Other personal expenses such as beverages and laundry
Shopping
Accommodations and Meals
Accommodations based on double, triple or quadruple occupancy. Equilibrio offers guest
casitas: each within its own private area of the farm complete with fruit trees, wildlife, and
paths leading to a secluded gazebo, outdoor desks, hammocks, and easels. Guest's casitas
feature a large bedroom with thatched-palm ceiling, two queen-sized beds (or more), 180degree open-air views, reading loft, walk-through closet, and indoor bathroom leading to your
private outdoor garden shower. The casitas are scrupulously screened-in to keep insects out;
yet, since the screens are virtually invisible, guests appreciate an unobstructed connection with
the outside environment. Exceptional ventilation combined with the shade of surrounding
trees keeps the casitas fresh throughout the day and night. Tropical breezes blow most of the
year and all casitas have multiple fans. Casitas include solar hot-water showers, two large safe
boxes, standard flush toilets, and standard electrical outlets (120 v as in USA). Purified water is
also available in your casita.
You will have three delicious, healthy meals each day. Breakfasts and Dinners are served at The
Riverside Lounge, also known as “the Hangoutorium.” This structure is nestled in nature, next
to the salt-water river. It is the perfect place to read in a hammock, relax, study, take in a
performance, watch a movie on the big screen, or have a music jam session. Lunches will be
served at a local family site close to your project work in the community.
Personal Care
We recommend that you bring a bodily insect repellent containing DEET
(diethylmethyltoluamide), in 30%–35% strength for adults (or 6%–10% for people with sensitive
skin) and sunscreen.
A note on cleanliness: the best way to prevent the spread of germs and illness is to wash your
hands thoroughly and often. The Nicaraguan people are friendly and eager to shake hands with
visitors and it is polite to oblige. Be careful not to touch your face, especially your mouth, nose
and eyes. Carry waterless antibacterial soap with you and use it discreetly throughout the day.
Simple, frequent hand washing easily prevents even cholera.
Traveling Protocol
Handling Your Luggage and Travel Documents
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It is recommended that you make two copies of your passport and any identification you may
carry. Leave one copy with someone in the U.S. and take the second copy with you, but keep it
in a place separate from where you will keep the original documents. This can be very helpful
in the event that a document is lost. You will be able to lock your passport and documents in
the safe supplied in your casita.
Your luggage will be inspected by customs officials upon arrival in Nicaragua, as part of airport
procedure. Be polite and cooperative and do not joke around with them. If you are provided a
luggage claim check and immigration form, make sure you have this handy as you de-plane.
Upon arrival in Nicaragua, locals may ask for your claim check or reach for your luggage in an
effort to help you - in return for a tip. It is best to refuse their assistance and handle the
claiming of your luggage by yourself.
How To Handle Solicitations
Be prepared for children and adults approaching you, begging for a dollar. You should refuse in
order to avoid drawing a crowd or putting yourself at risk. In many places we will visit there are
people who commonly panhandle and guards to keep solicitors away. It is important you
follow protocol and do not create a commotion.
While in Nicaragua, many people – especially children – may approach you and explain their
hardships. What you should realize is that when Americans are visiting Nicaragua,
neighborhood children will frequently show up in an effort to get handouts. The needs in
Nicaragua are certainly great, but please do not hand out anything without first discussing
doing so with your group leaders.
We do not recommend that you give your address, telephone number, or Facebook identity
etc. to anyone. This only will invite solicitation requests and, in some cases, collect phone calls
with requests for your money.
Bank and Phone Access in Nicaragua
Make sure you contact your bank and cellphone provider to alert them that you are traveling
abroad. You must have a cellphone plan specifically for Nicaragua and your provider may have
offers for limited texting and calling. Do not simply use your phone while in Nicaragua. During
preparation classes we will discuss free and low-cost apps, like WhatsApp and Viber, which may
be useful to you.
Health Information
There are no specific immunization requirements for entry into Nicaragua. Of course, there are
basic immunizations that every traveler should have, including tetanus, measles, mumps,
rubella and polio.
The National Center for Infectious Diseases offers excellent advice regarding travelers’ health.
Please visit the CDC website: http://wwwnc.cdc.gov/travel to find information relevant to travel
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in Nicaragua. Select “For Travelers,” scroll to find “Nicaragua,” select “Extended Stay / Study
Abroad,” and then click “Go.”
To be prepared for the health risks in Nicaragua, we formally ask that you make a visit to your
medical doctor and inform him/her of your travel plans and discuss recommended precautions.
Inform him/her that you will be staying in a mainly rural area in northern Nicaragua. You will
not be handling livestock. Your doctor may recommend the following (according to CDC
guidelines):
For All Travelers (must have)
Routine Vaccinations: Make sure you are up-to-date on routine or standard childhood vaccines.
These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis
vaccine (make sure you have had a tetanus vaccine in the last five years), varicella (chickenpox)
vaccine, polio vaccine, and your yearly flu shot.
For Most Travelers (discuss with your doctor)
Hepatitis A - CDC recommends this vaccine because you can get hepatitis A through
contaminated food or water in Nicaragua, regardless of where you are eating or staying. This
immunization usually includes a series of two shots six months apart.
Typhoid - You can get typhoid through contaminated food or water in Nicaragua. CDC
recommends this vaccine for most travelers if you are staying with friends or relatives, visiting
smaller cities or rural areas, or if you are an adventurous eater.
Some Travelers
Please view the CDC website: http://wwwnc.cdc.gov/travel before discussing other vaccines
with your doctor.
Malaria – For more information on malaria in Nicaragua, see malaria in nicaragua. You will
most likely NOT need to take prescription medicine to prevent malaria since you will be residing
in the Rivas region (southwest), where malaria transmission is not known to occur. However,
we advise you to speak with your doctor before making a determination.
Check with the main Volusia County Health Department located on 1845 Holsonback Drive in
Daytona Beach to see whether they offer vaccinations, which will be less expensive than
receiving them from your doctor (phone 386-274-0500).
Preventive Health
Be sure to bring medication for common ailments such as headache, diarrhea, constipation and
nausea, as such things are difficult to come by in Nicaragua. Carry your personal medications
in their original containers. Keep them with you as you travel in case the airlines lose your
luggage. Be sure you have an adequate supply for the duration of your trip.
In case of emergency, medical care is available in Nicaragua. However, we strongly advise that
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you always exercise care and best judgment at all times to help prevent accidents and injury. In
case of medical emergency, the nearest Health Center is open Monday to Friday from 8am to
4pm and is free -public- depending on the Nicaraguan government. The Private Clinic Roberto
Clemente is located ten minutes from Equilibrio and charges US$ 50 per visit to foreign patients
(http://www.nicaclinic.org ). For serious health problems you will need to travel to Managua to
Vivian Pellas Hospital (http://www.metropolitano.com.ni ). DSC and Equilibrio do not pay for
transportation or costs of medicines. Make sure you have “extra money” for emergencies and
your travel insurance handy.
Clothing
The weather will be hot and humid, so be sure that your clothing is lightweight yet durable and
appropriate for your various activities during your trip. The Nicaraguan people are modest in
their dress and we ask that you dress likewise. We will discuss wardrobe options during class
sessions before the trip, but here are some guidelines to consider:
Wear lightweight, light-colored clothing. Sports fabric blends are the best fabrics for
breathability. Aim for comfort, not style. Shop for your trip at thrift stores and yard sales.
Many times we leave our clothing behind in Nicaragua at the end of our trip.
We should try to blend-in as much as possible and match the level of Nicaraguan dress. Most
Nicaraguan women wear dresses every day, but team members can also wear lightweight pants
and modest, longer shorts / capris. When we are at school, we should dress in schoolappropriate clothing (business casual). Males and females wear collared shirts and pants.
Females may also wear dresses or skirts that come below the knee and over-the-shoulder
blouses or tops. When classes are not in session and we are doing manual labor or traveling we
may wear plain T-shirts without flashy or questionable advertising and appropriate shorts.
Please do not wear fitted tank tops, particularly those with spaghetti straps.
Socks and tennis shoes are best for the rugged, unpredictable terrain. It is very dusty – or very
muddy – depending on the season. Bring shoes that are good enough to prevent blisters and
give you good support, but old enough to get very dirty and perhaps left or thrown away. Many
bring sandals to wear, but remember that the terrain is rugged and walking will likely be easier
in rugged tennis shoes. Please bring modest swimwear for visiting the beach.
When it comes to jewelry, the most conservative thing is to leave it at home. In addition to
putting you at greater risk, it may be offensive to the people with whom you will be working in
comparison to their standard of living. At least only wear the most basic jewelry, such as simple
wristwatches, simple wedding bands and small earrings. Nicaraguan males normally do not
wear earrings, so you may want to consider doing likewise.
Bring along bandanas to keep the dust out of your hair, nose and mouths while traveling. They
also come in handy for wetting to cool off your face and neck and wipe away sweat.
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Laundry
You will most likely not have access to laundry service during your trip. However, you may be
able to wash your clothes by hand in your motel room sink / shower. You may wish to bring
along detergent in a Ziploc bag. Depending on the weather, your laundry may take a couple of
days to dry.
Packing for Your Trip
Try to pack lightly because you will have to carry your own luggage and you may not exceed 50
lbs total for checked luggage. The airlines have strict weight regulations. If you exceed weight
restrictions, you will have to pay excess baggage fees and/or leave the excess behind. To avoid
this predicament, please weigh your luggage in advance. Bring older, durable luggage that can
withstand dust and dirt. If possible, stick to one suitcase and one small carry-on.
Packing List
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Documents – passport and driver’s license (also bring a photocopy, packed separately. And leave
a photocopy back home with a trusted family member or friend), important phone numbers
Ziplock bags for your passport and camera / phone etc.
Clothing (as outlined earlier – outfits suitable for manual labor, business casual for school events,
casual-dressy church or special events) – at least one light pair of long pants and one light longsleeve shirt, swimwear, comfortable clothes for hotel downtime, T-shirts, pants, dresses and
skirts, shorts, pajamas, underwear and socks
Shoes –rugged everyday shoes and sandals
Personal care items - biodegradable soap, shampoo, and toothpaste, deodorant, powder,
toothbrush, feminie hygiene products, etc.
Waterless hand sanitizer
Prescription and over-the-counter medications, in original containers (Immodium etc.)
Toilet paper (always good to have one roll in plastic baggy as a back-up) and facial tissues
Disinfecting wet wipes
Plastic bags for wet clothing upon return
Beach Towel and washcloth
Bandanas (great for wetting to cool off and during work)
Hat, ponytail holders, headbands, sunglasses and sunscreen
Mosquito repellant and insecticide (clip-on works well to clip near you when sleeping)
Camera and charger
Wireless device for email (you will be able to get on internet in evenings; however your phone
most likely will not work unless you have international service – check with your cell provide
before leaving U.S.)
Flashlight and extra batteries
Reading material , Journal and pen
Water bottle (can be brought empty)
Snacks in a tight sealing plastic container (as suggested earlier)
Small purse, tote bag, backpack for carrying items back and forth from casita compound and
school (perhaps your carryon bag)
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Teaching Beyond Borders – Nicaragua Insight Adventure 2016
Student Application
Directions: Please complete the following pages by typing information in each field. Then print
and sign your completed application and submit to Dr. May by October 30, 2015.
Applicant Information
Last name
First name
Middle initial
State
Zip
Student ID#
Street Address
City
Email
Phone
Date of Birth
Passport Number
Nationality
Date of Expiration
*If you do not currently have a valid passport, you will need to expedite the process and provide evidence of a valid passport by March 2, 2015.
Program of Study
Current GPA
Number of Credit Hours
Completed:
Please list any honors, awards, and achievements
Have you ever traveled
abroad? (double-click on the
YES
NO
If so, when and where?
YES
NO
If yes, explain.
appropriate check-box to mark “check”)
Have you ever been convicted
of a felony or pleaded no
contest? (double-click on the
appropriate check-box to mark “check”)
How did you hear about this Study Abroad Program?
How do you plan to fund your participation?
Emergency Contacts
Name
Relationship
Phone
Name
Relationship
Phone
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Most Recent Employment and/or Internship Information
Company / School
Supervisor / Directing Teacher
From
Volunteer Activities
Organization
To
Phone
From
To
From
To
Activity
Organization
Activity
Personal Statement
In the space provided below, please describe why you are interested in participating in this
study abroad program and what you hope to gain from this experience (500 words or less).
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
I am aware that payment deadlines exist and failure to meet these deadlines will result in being
dropped from the program. I also understand that payments made toward this program are not
refundable after March 7, 2016.
Signature
Date
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Daytona State College Release Form
Teaching Beyond Borders - Nicaragua 2016
VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
FOR INTERNATIONAL TRAVEL TO NICARAGUA 2015
CAUTION: THIS IS A RELEASE OF LEGAL RIGHTS, READ AND UNDERSTAND IT BEFORE SIGNING.
Daytona State College is a non-profit educational institution. References to Daytona State
College (henceforth College or DSC) include the District Board of Daytona State College its
officers, officials, employees, volunteers, students, agents, and assigns.
I (type/print your name)___________________________________________, freely choose to
participate in the Teaching Beyond Borders – Nicaragua Study Abroad Program – Summer
2016 (henceforth referred to as the Program).
In consideration of my voluntary participation in the Program, I agree as follows:
SPECIFIC HAZARDS OF TRAVEL: Specific dangers endemic in the Program’s area of travel may
include but are not limited to the following:
Health Risks – participating students must understand the current health risks involved when
traveling to Nicaragua and must be cleared by a physician. Visit http://wwwnc.cdc.gov/travel
for the current health risks provided by the Centers for Disease Control and Prevention.
Travel Advisory - The Department of State urges U.S. citizens to exercise caution when visiting
Nicaragua. Participating students must be aware of these conditions (by visiting:
http://travel.state.gov/content/passports/en/country/nicaragua.html ) and agree to adhere to
traveling protocol outlined in the SAP information packet provided.
RISKS FOR TRAVEL/STUDY/WORK ABROAD: I understand that my participation in the Program
specified above involves risk not found in activities at the College or within DSC. These risks
include traveling to and within and returning from one or more foreign countries; foreign
political, legal, social, transportation, health and economic conditions; different standards of
design, safety, and maintenance of buildings, public places, and conveyances; local medical
facilities and providers; and local weather conditions.
INSTITUTIONAL ARRANGEMENTS: I understand that the College is not an agent of, and has no
responsibility for providing any services including food, lodging, travel, or other goods or
services, associated with the Program.
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INDEPENDENT ACTIVITY: I understand that the College is not responsible for any loss or
damage I may suffer when I am traveling with the Program. In addition, I understand that
participation in this Program is entirely at my own expense and risk.
HEALTH AND SAFETY: I have been advised to consult with a medical doctor with regard to my
personal medical needs. I state that there are no health-related reasons or problems that
preclude or restrict my participation in this Program. I have obtained the required
immunizations, if any.
I understand that I may be required to pay up front for my medical expenses that I incur while
traveling and in the host country. Further, I understand that my insurance policy may not cover
any medical expenses incurred during international travel that it is my responsibility to
purchase appropriate medical insurance. I recognize that the College is not obligated to attend
to any of my medical or medication needs, and I assume all risk and responsibility therefore. In
case of a medical emergency occurring during my participation in this Program, I authorize in
advance the representative of the Program to secure whatever treatment is necessary and is
warranted under the circumstances regarding my health and safety. I agree to pay all expenses
relating thereto and release the College from any liability for any actions.
STANDARDS OF CONDUCT: I understand that each foreign country has its own laws and
standards of acceptable conduct, including dress, manners, morals, politics, drug use and
behavior. I recognize that behavior, which violates those laws or standard, could harm my own
health and safety. I will become informed of and will abide by all such laws and standards for
each country to or through which I will travel during the Program.
I will attend to and assume responsibility for any legal issues or problems I encounter with any
foreign nationals or government of the host country.
TRAVEL CHANGES: If I become separated from the Program group, fail to meet a departure
airplane, bus, or train, or become sick or injured, I will, to a reasonable extent, and at my own
expense seek out, contact, and reach the Program group at its next available destination.
ASSUMPTION OF RISK AND REALEASE OF LIABILITY: Knowing the risks described above, and in
voluntary consideration of being permitted to participate in the Program, I agree to release,
indemnify, and defend the College and their officials, officers, employees, agents, volunteers,
sponsors, and students from and against any claim which I, the participant, my parents or legal
guardian or any other person may have for any losses, damages or injuries arising out of or in
connection with my participation in the Program.
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SIGNATURE: I indicate that by my signature below that I have read the terms and conditions of
participation and agree to abide by them. I have carefully read the Release Form and
acknowledge that I understand it. No representation, statement, or inducements, oral or
written, apart from the foregoing written statement, have been made. The Release Form shall
be governed by the laws of the State of Florida, United States of America, which shall be the
forum for any lawsuits to interpret this release. If any portion of this Release Form is held
invalid, the rest of the document shall continue in full force and effect.
Signature of Program Participant
Date
Signature of parent or Legal Guardian (if a student is a minor)
Date
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The Fundación Aprender (Learning Foundation) and Equilibrio Release Form
Teaching Beyond Borders - Nicaragua 2016
VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
CAUTION: THIS IS A RELEASE OF LEGAL RIGHTS, READ AND UNDERSTAND IT BEFORE SIGNING.
The conditions below constitute the agreement between The Fundacio Aprender, Equilibrio Yoga
Art Nature Retreat (Retiro de Arte y Yoga Equilibrio) and you _______________________________
as a guest at Equilibrio.
(type or print full name above)
Health and Fitness Requirements
By signing this agreement, you declare to be in good physical and mental health in order to be a
guest at Equilibrio Yoga Art Nature Retreat . The closest medical facilities for serious problems are
in Managua. In the event that these facilities are needed, medical assistance and evacuation
expenses will be your responsibility. Additionally, Equilibrio Yoga Art Nature Retreat (Retiro de
Arte y Yoga Equilibrio) reserve the right, in their absolute discretion, to refuse a participant the
right to participate in any physical activities on grounds.
In case of medical emergency, the nearest Health Centre is open Monday to Friday from 8am to
4pm and is free -public- depending on the Nicaraguan government. The Private Clinic Roberto
Clemente is located ten minutes from Equilibrio and charges US$ 50 the visit to foreign patients
(http://www.nicaclinic.org). For serious health problems we recommend to travel to Managua to
Vivian Pellas Hospital (http://www.metropolitano.com.ni ). Equilibrio does not pay for
transportation or costs of medicines or doctors in medical emergencies Make sure you have “extra
money” for emergencies, and your travel insurance handy.
Photography
Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga Equilibrio) reserves the right to use
photographs or videos from your stay as a guest of Equilibrio Yoga Art Nature Retreat for
promotional purposes. By making a reservation with Equilibrio Yoga Art Nature Retreat (Retiro de
Arte y Yoga Equilibrio), you agree to allow your image to be used in such photography. If you
prefer that your image not be used, please notify Equilibrio in writing below this form. Thanks!
Force Majeure
If Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga Equilibrio) and/or the trip leader are
prevented (directly or indirectly) from performing any of their obligations under this agreement by
acts of Nature, strikes, trade disputes, fire, breakdowns, interruption of transport, government or
political action, acts of war or terrorism, acts or omissions of a third party, or for any other cause
whatsoever outside of Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga Equilibrio) and/or
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the trip leader's reasonable control, Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga
Equilibrio) and/or the trip leader will be under no liability whatsoever to you and may cancel the
retreat or take any other action.
Assumption of Risk
You acknowledge that adventure travel is more challenging and demanding, with a
commensurately higher level of risk compared to conventional vacations, and that it involves
potential exposure to injury. You acknowledge that you will be staying on a farm in rural Nicaragua,
surrounded by nature, and with all that means bugs, snakes, scorpions, etc.; and that Nicaraguan
standards of accommodation, transport, health care, hygiene, safety and service provision are
generally not as high as those standards in your country of residence and will require flexibility and
patience on your part.
Release and Waiver of Liability
In consideration of Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga Equilibrio) accepting
your reservation, you release, waive, discharge, hold harmless and agree to indemnify John James
Womack / Gabriela Alejandra Prado / Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga
Equilibrio), its officers, its employees, its agents, its volunteers, its licensees, other representatives,
and trip leaders from all claims, actions, or losses for bodily injury, emotional trauma, property
damage, wrongful death, loss of services, loss of profits, as well as consequential, exemplary,
indirect or punitive damages, or otherwise which may arise out of or occur during your travel in
connection with your stay as a guest at Equilibrio Yoga Art Nature Retreat, or any activities
conducted in conjunction there within. Regardless of the situation or circumstances giving rise to
the claim, you waive any claims that you have, or may at any time have, in Nicaragua or your
country of origin or residency, against John James Womack / Gabriela Alejandra Prado / Equilibrio
Yoga Art Nature Retreat (Retiro de Arte y Yoga Equilibrio) and its employees or volunteers.
You agree, by accepting the additional inherent dangers and risks associated with being a guest at
Equilibrio Yoga Art Nature Retreat which is located in a rural area in Nicaragua, not to make any
claim against or seek any compensation ( in Nicaragua or your country of origin or residency) from
John James Womack / Gabriela Alejandra Prado / Equilibrio Yoga Art Nature Retreat (Retiro de
Arte y Yoga Equilibrio) and its employees or volunteers in respect to any personal injury, illness, or
death suffered by you, or damage to or loss of property sustained by you as a result of your
participation in any of the activities that you choose to be part of including, without limitation, any
extracurricular activities you may engage in during your stay as a guest of Equilibrio Yoga Art
Nature Retreat, whether or not sponsored by Equilibrio Yoga Art Nature Retreat (Retiro de Arte y
Yoga Equilibrio).
I certify that I fully understand and agree with all of the above information, and that I am solely
responsible for my health, safety and well-being while participating in all the activities and during
my whole stay at Equilibrio Yoga Art Nature Retreat (Retiro de Arte y Yoga Equilibrio).
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I agree that I will inform the manager of any activity which I cannot perform safely, and that I will
not perform any activity which I feel is likely to cause me to injure myself.
I understand that there are risks associated with any activity and physical exercise and I agree to
hold Gabriela Alejandra Prado, John James Womack and Equilibrio Yoga Art Nature Retreat (Retiro
de Arte y Yoga Equilibrio), its employees or volunteers harmless from any and all responsibility for
any injury that may arise during my stay as a guest of Equilibrio Yoga Art Nature Retreat.
Complete Name:
Country of Origin:
Passport Number:
Today’s Date:
Signature: ___________________________________________
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TEACHER RECOMMENDATION
Teaching Beyond Borders - Nicaragua 2015
Directions: Students, please complete the top portion of this form. Select this one page and
either email or print for your professor / teacher.
To be completed by applicant
Last name
First name
Student ID
Date
Program of Study
Current GPA
Number of Credit Hours
Completed
Teacher Recommendation
Please use the space provided to explain what qualities the above student possesses that would
benefit the Teaching Beyond Borders Nicaragua project and any other pertinent information
that may help us in selecting participants:
Last name
Campus / School
First name
Date
Office Phone
You may email this letter as an attachment to mayd@daytonastate.edu or print, sign, and mail to:
Dr. Donald May, Daytona State College, College of Education, Bldg 200 Nunamann Hall, Rm 308,
1200 W International Spdwy Blvd, Daytona Beach, FL 32114
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