TEACHING BEYOND BORDERS
A Daytona State College Service-Learning Initiative
HAITI 2015
Summer 2015
Student Information and Application
Welcome
Dear Daytona State College Student,
We are very pleased you have expressed interest in joining us for the Summer 2015
Teaching Beyond Borders expedition to Cap Haitien, Haiti. This is not your average study
abroad program (SAP) and will most likely be a very meaningful and life-changing experience.
This study abroad program is made possible through the cooperation and partnerships
of several non-profit organizations. Our partner for this project is Projects 4 Haiti
http://projectsforhaiti.org/ , which is a 501c(3) organization that has been working in Haiti to
train teachers and make a difference in education for the children of Cap Haitien. We are
fortunate to be supported by Missionary Flights International (MFI)
http://www.missionaryflights.org/mfi/index.php , which operates out of Fort Pierce, Florida,
and is capable of flying us directly into Cap Haitien, thus avoiding an arduous overland journey
from Port Au Prince.
Please read this entire information and application packet before submitting
your application. Enclosed you will find several documents required by Daytona State College
and Projects 4 Haiti. 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 or Prof. Hensler at your earliest convenience. Your
application will then be reviewed. Once you are approved you will be given a clearance form to
begin submitting payments for this SAP.
Space is limited, so it is very important your application be submitted in a timely
manner, you provide all needed documentation, 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 (200/301D) if you have any
questions regarding the SAP trip or the information in this packet. Thank you again, for
expressing willingness to join our endeavors in Haiti.
Sincerely,
The Teaching Beyond Borders Team
Daytona State College
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TABLE OF CONTENTS
Study Abroad Program Information
Overview of Study Abroad Program ……………………………………………………………
Purpose of Teaching Beyond Borders …………………………………………………………
Teaching Beyond Border Mission, Vision, and Values ………………………………..
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
Teaching Beyond Borders: Study Abroad Application …………………………………
Teacher Recommendation Form ………………………………………………………………..
Daytona State College Release Form …………………………………………………………..
Projects 4 Haiti Release Form ……………………………………………………………………..
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Overview of Study Abroad Program
The purpose of the program is to create sustainable cross-cultural connections and servicelearning opportunities for the institution and you, the students of Daytona State College (DSC).
This project is part of a service-learning in education course EDG 2905 offered during the
Summer A term.
This program includes annual service-learning excursions to Haiti in which Daytona State
College students implement a project to meet the needs assessed by students the previous year
and then conduct a current needs assessment before returning to DSC. Upon returning to DSC,
students create presentations to communicate to stakeholders and sponsors regarding their
experiences and the current needs that should be addressed the following year. While in Haiti
you will benefit from the experiences of teaching English and providing other needed services.
Prior to going to Haiti, you will spend time in the classroom at Daytona State College learning
about the needs assessments conducted in the region the previous year and designing a project
to implement in Haiti in order to meet the identified needs. You will be instructed how to teach
English language learners and develop mini-lessons you can implement in the field classrooms.
You will also prepare by learning basic Haitian Creole language and greetings, cultural norms,
general characteristics of the region and inhabitants, and relevant historical factors.
We will then travel to Cap Haitien, Haiti and spend time working with the Projects 4 Haiti staff
and the children of Cap Haitien. The majority of our time will be devoted to teaching lessons
and interacting with and conducting special events for the students. A few structured
excursions will also be conducted because it is important for you to see many diverse aspects of
the Haitian culture. For instance, we will try to see The Citadelle, the Cathedral Notre Dame de
Cap Haitien, and visit with local leaders and others who serve the needs of the community.
We will return to the DSC classroom for debriefing and finalizing your multimedia projects.
Your final projects will be designed to communicate your personal experiences and educational
growth during the service-learning program and will be presented to stakeholders, sponsors,
and the greater DSC community.
The experience of study abroad travel, in general, always has an effect on all of us as we are
able to broaden our viewpoint by seeing another part of their world. However, being able to
contribute and make a difference during these same travels will create a lasting memory that
will most likely shape your outlook in the future.
Purpose of Teaching Beyond Borders
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
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(TBB) program to diligently work to increase access to a quality education for all children,
especially those children who live in disadvantaged regions of the world like Haiti.
Haiti is undoubtedly the poorest country in the Western Hemisphere, with a per capita income
of $200 per year. Families are typically large, often with six to eight children. Life expectancy is
low, with one-third of children dying from malnutrition or infection before age 5. An effective
project must be holistic in its approach if we are to make a difference in the lives of children
and promote education. Sometimes our efforts may be focused on feeding people in need,
providing increased access to education for needy students, supplying safe water, or offering
micro-enterprise opportunities to willing workers. In most cases our efforts go beyond the
borders of the classroom.
The conditions in Haiti continue to improve, but Haiti remains one of the countries with the
lowest school enrollment rates in the world. According to the recent Human Rights Watch
World Report, prior to the earthquake in 2010, only about half of primary school-age children in
Haiti attended school. In 2011, President Martelly introduced a plan for free universal primary
education. Yet, as of 2014, only 67 percent of children attend primary school and less than 30
percent of these children reach 6th grade. At the secondary level the enrollment figure drops to
53 percent with less than 20 percent graduating. Many of these children do not pass the
Government exams and receive no accommodations to continue their schooling. The literacy
rate among adults and youth varies from 50 to 66 percent.
TBB seeks to change these trends by collaborating with teachers in Haiti to enhance teaching
and learning and to promote literacy. Teachers in Haiti face enormous challenges. Out of
approximately 60,000 teachers in Haiti, 84 percent are not qualified. Teachers also lack training
opportunities, materials and access to technology, as well as adequate remuneration.
Teaching Beyond Border Mission, Vision, and Values
The mission of Teaching Beyond Borders is to teach our students beyond the conventional
classroom by giving them meaningful service-learning experiences abroad. Our efforts serve to
increase access to a quality education, promote literacy, and better serve the needs of
disadvantaged children.
Vision: Teaching Beyond Borders makes a difference in the lives of children by improving the
effectiveness of their education.
To carry out its mission and fulfill this vision the Teaching Beyond Borders program has
established the following values:
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Create sustainable cross-cultural connections
Provide increased access to a quality education
Embrace diversity and emphasize all students can learn
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Promote literacy for the whole community
Embrace excellence and foster innovation
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 15, 2014 – applications disbursed
November 18, 2014 – information session
December 2, 2014 – applications due
December 9, 2014 – students will be informed of acceptance to the program
December 17, 2014 – $87 minimum deposit due
January 20, 2015 – $300 minimum payment due
February 17, 2015 - $300 final payment due (must reach total payment of $687)
March 3, 2015 - must provide evidence of valid passport
April 2015 – register and pay for EDG 2905 class
Students may complete payments earlier or pay in lump sum. All Study Abroad Program
deposits and payments are refundable prior to February 17, 2015. After February 17, 2015 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
December 2, 2014. You will then secure your place in the program by submitting your $87
deposit to 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.
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Estimated Student Costs
Teaching Beyond Borders
EDG 2905 Directed Study in Education Summer 2015
Based on a minimum of 8 student participants. (NOTE: The following budget takes
into account the Co-Curricular Activities and Professional Development funding
awarded to defray student cost for the program).
Item
Transportation
Type
Airfare
Description
MFI Airline $530
Baggage fee $85
Cost
$615
Round trip from Fort Pierce, FL to Cap Haitien,
Haiti
Ground Round Trip to and from MFI Fort Pierce Airport
Accommodations Hotel
Covers double occupancy room and breakfast
at Hotel Mont Joli
Guides, Drivers,
Covers all fees for drivers, guides and
and Interpreters
interpreters
Entrance Fees
Travel Insurance
DSC Funding
The Citadel La Ferriere $5
Cormier Plague (beach resort) $30
Travel insurance (covers emergency evacuation)
Subtotal
Less DSC funding per student
*Total Cost per Student
$30
$1,091
$113
$35
$80
$1964
-$1,277
$687
*Price is based on a minimum of 8 participants
Not included:
 Tuition for course
 Costs of obtaining passport
 Excess baggage fees over allotted 50 lbs. ($1.70/lb.)
 Meals (lunch and dinner) and gratuities (~$30 / day = $210)
 ~$10 round trip horse ride at Citadel
 Other personal expenses such as beverages and laundry
 Shopping at Tourist Market.
Accommodations and Meals
Hotel Mont Joli (http://hotelmontjoli.net/ ) is located on the hill above the city of Cap-Haitien.
They offer continental breakfast with the purchase of your room. By Haitian standards, the
hotel is considered quite luxurious with electricity and indoor plumbing. The water served by
dining services is filtered, however you may want to stick to drinking bottled water. Do not
drink the water from the shower or tap in your room. You may want to bring along a pillow and
an extra towel.
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We will be visiting other dining establishments for lunch and dinner, and may be invited to have
lunch / dinner by our hosts and/or community leaders. As stated above, we recommend you
bring at least $30 / day for meals and beverages.
In Haiti you won’t be able to visit a grocery or convenience store, so plan ahead by bringing
snacks with you. Suggestions are crackers or cookies, pre-wrapped snacks, dried fruit, trail mix,
candy that does not melt, peanut butter, etc.. Be sure to bring a plastic container with a tight
fitting lid to store these in.
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 Haitian 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 throughout the day. Simple,
frequent hand washing easily prevents even cholera.
Traveling Protocol
Handling Your Luggage and Travel Documents
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.
Your luggage will be inspected by customs officials upon arrival in Haiti, 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 Haiti, 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.
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While in Haiti, many people – especially children – may approach you and explain their
hardships. What you should realize is that when Americans are visiting Cap Haitien,
neighborhood children will frequently show up in an effort to get handouts. The needs in Haiti
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
from Haiti with requests for your money.
Bank and Phone Access in Haiti
Make sure you contact your bank and cellphone provider to alert them that you are traveling
abroad and where. You must have a cellphone plan specifically for Haiti and your provider may
have offers for limited texting and calling. Do not simply use your phone while in Haiti. During
preparation classes we 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 Haiti. 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
in Haiti. Select “For Travelers,” scroll to find “Haiti,” select “Extended Stay / Study Abroad,” and
then click “Go.”
To be prepared for the health risks in Haiti, 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 rural area in northern Haiti but will be traveling to a
more urban city often. You will not be handling livestock or working in a medical care capacity.
He or she may recommend the following:
For All Travelers
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 Haiti, regardless of where you are eating or staying.
Immunization series includes two shots six months apart. (Not for most travelers, but may also
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discuss with your doctor the need for hepatitis B immunization series of three shots two and
four months apart.) If you begin the Hepatitis A and B vaccination series but are not able to
complete them due to a lack of time before your trip, you can count on at least some degree of
protection. Your health care provider is the best source of advice on the matter of
immunizations.
Malaria - You will need to take prescription medicine before, during, and after your trip to
prevent malaria. Your doctor can help you decide which medicine is right for you, and also talk
to you about other steps you can take to prevent malaria. See more detailed information about
malaria in Haiti. The National Center for Infectious Diseases states “Travelers to all areas of
Haiti are at risk for malaria.” As of January 2006 their recommendation was to take
chloroquine or hydroxychloroquine sulfate to prevent malaria in Haiti.
Typhoid - You can get typhoid through contaminated food or water in Haiti. 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. Most likely, this will not apply to you on this
trip and many doctors no longer recommend this vaccine. Discuss this with your doctor.
Cholera has also been present in Haiti for the past few years. Be sure to discuss this with your
medical professional. This is no vaccine for cholera. The very best defense against cholera is
simple, frequent hand washing.
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).
Be sure to bring medication for common ailments such as headache, diarrhea, constipation and
nausea, as such things are difficult to come by in Haiti. 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 Cap Haitien through private hospitals run by
missionary groups. However, these hospitals may not always be easily accessed depending on
where you are. Exercise care and your best judgment at all times to help prevent accidents and
injury.
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 Haitian people are modest in their
dress and we ask that you dress likewise.
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.
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Many times we leave our clothing behind in Haiti at the end of our trip.
We should try to blend-in as much as possible and match the level of Haitian dress. Most
Haitian 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 school-appropriate
clothing (business casual). Males wear collared shirts and pants. Females normally 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. Sleeveless dresses and
blouses are suitable for ladies, but please do not wear fitted tank tops, particularly those with
spaghetti straps.
If you elect to attend church on Sunday, you will not want to feel underdressed. Haitians dress
up for church services. Please bring at least one nice outfit to wear to church service or special
occasion. We do not need to be super-formal, but men should wear collared shirts and slacks.
Most Haitian women wear a nice dress for church.
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. Haitian males 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.
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 all luggage. These are strict regulations. If the flight is not at weight capacity, MFI
may allow you to pay for your excess baggage. If the flight is at capacity, you will have to leave
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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
Clothing (as outlined earlier – outfits suitable for manual labor, business casual for school events,
casual-dressy church or special events, swimwear, comfortable clothes for hotel downtime) - Tshirts, pants, dresses and skirts, clothing for church, shorts, pajamas, underwear and socks,
swimsuit
Shoes – dress shoes for church, rugged everyday shoes, sandals
Personal care items (soap, shampoo, deodorant, powder, toothbrush, toothpaste, feminie hygiene
products, etc.)
Prescription and over-the-counter medications, in original containers (Immodium etc.)
Toilet paper (good to have a back-up) and facial tissues
Disinfecting wet wipes (for keeping you and the bathroom clean)
Plastic grocery bags for toilet paper waste
Towel and washcloth, pillow (if needed)
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)
Waterless hand sanitizer
Snacks in a tight sealing plastic container (as suggested earlier)
Small purse, tote bag, backpack for carrying items back and forth from housing compound and
school (perhaps your carryon bag)
Your luggage may be inspected by customs officials upon arrival as part of airport procedure.
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Teaching Beyond Borders – Service-Learning in Haiti
Study Abroad Application - Haiti 2015
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 December 2, 2014.
Applicant Information
Last name
First name
Middle initial
Email
Phone
Street Address
City
Student ID #
State
Zip
Date of Birth
Passport Number
Date
Weight (needed for MFI flight) 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 may
not be refundable.
Signature
Date
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TEACHER RECOMMENDATION
Teaching Beyond Borders - Haiti 2014
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 Haiti 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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Daytona State College Release Form
Teaching Beyond Borders - Haiti 2015
VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
FOR INTERNATIONAL TRAVEL TO HAITI 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 (print your name)___________________________________________, freely choose to
participate in the Teaching Beyond Borders – Haiti Study Abroad Program – Summer 2015
(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 Haiti 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
Haiti. Participating students must be aware of these conditions (by visiting:
http://travel.state.gov/travel/cis_pa_tw/tw/tw_6051.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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Projects 4 Haiti Release Form
Teaching Beyond Borders - Haiti 2015
VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
FOR INTERNATIONAL TRAVEL TO HAITI 2015
CAUTION: THIS IS A RELEASE OF LEGAL RIGHTS, READ AND UNDERSTAND IT BEFORE SIGNING.
For adults eighteen years of age and older
In consideration of being accepted by Projects 4 Haiti for participation in a short-term Study
Abroad trip in Haiti, I hereby acknowledge that I do this as a service-learning project and that I
am receiving no wages for this service.
I understand all reasonable safety precautions will be taken at all times by Projects 4 Haiti and
its agents while hosting my participation. I understand that Projects 4 Haiti is a non-profit
organization and as such does not carry liability insurance for any loss due to damage, which
may occur outside the United States. I understand the possibility of unforeseen hazards and
know the inherent possibility of risk. I do hereby release, forever discharge and agree to hold
harmless Projects 4 Haiti, its directors and its staff thereof from any and all liability, claims or
demands for personal injury, sickness or death, as well as any property damage and expenses,
of any nature whatsoever which may be incurred by the undersigned and the participant that
occur while said person is participating in work or recreational activities in Haiti with Projects 4
Haiti.
The undersigned further agrees to hold harmless and indemnify said Projects 4 Haiti, Inc., its
directors and agents for any liability sustained by said acts of said participant, including any
expenses incurred attendant thereto.
I understand that if I engage in activities, which adversely affect the mission and moral
standards of Projects 4 Haiti I will be subject to immediate dismissal from participation with
them and will be responsible to make alternate transportation arrangements, at my own
expense.
I consent to the use of any video images, photographs, audio recordings or any other visual or
audio reproduction that may be taken of the subject of this release while in Haiti to be used,
distributed or shown as Projects 4 Haiti sees fit.
I am aware of the recommendations regarding seeking a physician’s approval of good health
appropriate for travel to Haiti, Tetanus shots/boosters, Hepatitis A vaccinations, Hepatitis B
vaccinations and preventative medications for Typhoid and Malaria. The undersigned
acknowledges personal responsibility to choose whether to follow these recommendations and
agrees to hold harmless and indemnify Projects 4 Haiti in the event of the development of any
disease or any other health problems incurred by the subject of this release while in Haiti.
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Signature ________________________________________ Date ___________________
The undersigned consents to the admission of medical intervention, including but not limited to
first-aid, hospitalization, injections, anesthesia, surgery or any other form of medical treatment
necessitated by illness or injury that may require the same. In the event of the necessity of
such care or treatment as heretofore described, the undersigned agrees to hold harmless and
indemnify said Projects 4 Haiti, its directors and agents from any acts of malfeasance, and/or
failure to act on the part of those chosen to administer medical care on behalf of the
participant.
Signature _________________________________________ Date ___________________
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