• Please answer all information as completely as possible (type in English). Peacework and its global partners will use the following information for registration and placement purposes only.

  • All information is completely confidential and will only be shared with the group leader, the host organization in the destination country, individuals providing medical treatment in an emergency, or as required by the local agencies overseeing different fields of service.

  • In addition, participants who may be working in a professional capacity must provide credentials, such as medical licensing or contractor credentials, according to guidelines of the host country's requirements. 


Personal & Health Information

Full name exactly as it appears on your passport *
Full name exactly as it appears on your passport
Project beginning date *
Project beginning date
Project ending date *
Project ending date
Date of birth *
Date of birth
Gender *
Passport expiration date *
Passport expiration date
Preferred physical mailing address *
Preferred physical mailing address
Enter the name of the institution with which you are affiliated
Physical address of employment or study
Physical address of employment or study
Enter the address of the institution with which you are affiliated
If applicable
If applicable
If applicable
If applicable
Enter "none" if not applicable
Enter "none" if not applicable
Enter "none" if not applicable
Enter "none" if not applicable
Enter "none" if not applicable
Enter "N/A" if you entered "none" in the field "Medications you are currently taking that are critical to a medical response"
Enter "N/A" if you entered "none" in the field "Medications you are currently taking that are critical to a medical response"
Peacework automatically registers participants for our global medical plan. This plan provides reimbursement up to the plan limits for medical services, repatriation, and follow-up treatments. The cost is included in the program unless an individual private option is chosen.
Physician's address
Physician's address
Other information about you or your participation that would be important for the leader, your host in the destination country, or for those managing your arrangements.
If this does not apply to you, please enter "N/A" in this field; Declaration and Release of Liability (Please read the terms & conditions as outlined below prior to providing your digital signature
If this does not apply to you, please enter "N/A" in this field; Declaration and Release of Liability (Please read the terms & conditions as outlined below prior to providing your digital signature.
Date *
Date

Declaration and Release of Liability

I, along with all members of my family in consideration of the benefits derived, if accepted for a volunteer service placement, hereby voluntarily waive any claims against and hold harmless the Peacework Development Fund, Inc. (herein and elsewhere referred to as " Peacework"), and its partners and agents (including staff, directors, officers, sponsoring institutions, volunteers, and international hosts) for any and all liabilities in connection with the activities and services provided for the above volunteer placement.

I agree that Peacework and its partners and agents will make all due effort to secure the best possible arrangements, supervision, and planning for this placement and that some conditions, services, and the reliability of service vendors are beyond the control of the organization. Furthermore, I acknowledge that the organizational fee and all airfares and other program obligations become non-refundable once travel arrangements have been approved and completed and I agree to pay in full all placement costs assigned to me. I agree that the total cost for organization and arrangements shall be paid to Peacework as a sign of my final commitment to participate in this placement. If I must withdraw from the program, I acknowledge that the organizational cost is non-refundable and that other costs for accommodations and services may be refundable to the extend those funds are not already obligated at the service location and that I will be required by Peacework to pay for all placement expenses. 

  • I will carry a copy of my passport and visa at all times.

  • I enter into this project in a spirit of learning and genuine respect for the world's cultures, traditions, and customs.

  • I have read Peacework's recommendations for safety and security and agree to adhere to those guidelines throughout the program abroad.

  • I agree that the sponsor and Peacework representatives have ultimate authority to enforce parameters of behavior and responsibility, including removal from the program without reimbursement of any costs.