Participant Information Form

We are excited to take this trip to Mali, West Africa with you. To help ensure a safe and enjoyable experience, please complete the following form about any food sensitivities or health concerns we should be aware of.

Full Name

Date of Birth

Phone

Emergency Contact

Relationship

Emergency Contact Phone

Emergency Contact Email

Food Allergies

Food Intolerances

Special Diet

Dietary Restrictions

Medical Conditions

Medications

Medical History

Physical Limitations

Health Concerns

Allergies

Additional Information

eSignature

Acceptance

By typing my full name here, I agree to all of the terms and conditions of this Release of Claims and Waiver of Liability (referred to as “Release”).

Privacy Notice:

The information collected in this form is confidential and will only be used to ensure your health and safety during the trip. If you have any concerns about providing this information, please feel free to reach out to us personally.