Apply Now

Apply Now

Fill out the form below to apply to join the World Wide Village Team.

Basic Contact Information

Name*

Current Mailing Address*

State*

Cell Phone*

House Phone

Work Phone

Date of Birth*

Sex*

MaleFemale

Email*


Employment Information


Passport Information*

Passport Expiration Date

Copy of Passport Photo

Accepted file types: .jpg, .gif, .png, .pdf | Max file size: 2mb

General Information

Team Name*

Please provide the team name, for the group you wish to travel with. If you wish to start a new team, please type the word "NEW" in this field.

Team Date

Please provide the team's travel date

Religious Affiliation / Denomination and place of worship (if any)

Physical or Medical limitations*

Medications*

Allergies and/or Dietary Needs

Vaccinations

Please check the vaccinations, shots and/or boosters for which you are current. World Wide Village strongly suggests team/intern participants are current on all recommended vaccinations, shots and/or boosters. If you understand the risks of not vaccinating and choose not to, please select the "I choose not to vaccinate" option.

Insurance Coverage*

Are you covered by accident and health insurance?

YesNo

Insurance for Foreign Travel?*

Does your insurance coverage include coverage for foreign travel?

YesNo

Child Sponsorship

Do you sponsor a child through World Wide Village?

YesNo

Child Sponsored

If so, please state the sponsored child’s name, gender & sponsor’s name (if not you).

Foreign Language

Please select the option(s) for the language(s) you speak and/or write (if any) other than American English.

Would you like to lead activities?

Please specify if you would feel comfortable leading activities.

YesNo

Skills, Expertise, and Interests

Please list specific skills/expertise/interests you have to offer, as this information helps us determine what activities to plan while you are in Haiti.

Description of Skills, Expertise & Interests*

Please provide a brief description of your experience in each area you checked, above.

For Medical Volunteers

Please list special skills and experience with international healthcare. Please list any/all medical license information and state issued.

In Case of Emergency

In this section, you will provide Emergency Contact Information. The contact person(s) listed, should not be a minor and should not be in Haiti with you. If you are under 18 years of age, one of the contacts should be a parent.

Emergency Contact Name*

Emergency Contact Email*

[confirm_email* em-email placeholder "Confirm Email*"]

Emergency Contact Mailing Address*

State*

Emergency Contact Phone*

Cell Phone*

House Phone

Work Phone

"Get to know you" Survey

Please help us get to know you better by responding briefly to the following questions.

Reason for joining a Haiti team

Why do you want to be a World Wide Village Vision Team volunteer and what are your goals for this trip? Why now, and why Haiti?

Personal Travel

Have you traveled to a foreign country previously? If yes, in what context?

Personal Strengths

What strengths do you see yourself contributing to this Vision Team?

Personal Free Time

What do you enjoy doing in your free time?

Personal Blog

Are you planning on keeping a blog while in Haiti? If so, please paste the URL here. If not, skip over this question

Personal Relation

Are you related to anyone on the team? If so, who and what is the relation?

Help Spread the Word

Please list some of your local magazines/newspapers (if any) that might be interested in learning more about your team experience.

Terms of Service (ToS)

Our Terms of Service (ToS) includes Acknowledgement of Risk, Waiver and Release Agreement.

I have agreed to participate in a Vision Trip to Haiti under the direction of World Wide Village, Inc. (“WWV”). I understand that this waiver covers my participation with World Wide Village, Inc. for this trip and any subsequent trips for one calendar year from the date of signature. I understand and acknowledge that my participation in this trip is wholly voluntary. I hereby represent and agree to the following:

  1. Medical Authorization: In the event of a medical emergency, I herby authorize those in charge to take me to the nearest licensed physician, medical center or hospital and to secure necessary treatment (medications, injections, anesthesia or surgery) to protect my well being. I will be responsible for all medical costs not covered by my insurance.
  2. I am prepared physically, emotionally, mentally and spiritually for this experience. The scheduling, environment and other foreign country and travel conditions are not adverse to me. I will be flexible and have a servant attitude.
  3. I agree to indemnify and hold harmless WWV from any and all actions, suits, damages, or claims arising from any injury (including death), loss, or damage to me (the undersigned) during this waiver term. I have reviewed the Haiti Travel Warning. I am aware of and understand the risks of travel to, in and around Haiti and my participation on each trip.
  4. I grant to any of the World Wide Village (WWV) or World Wide Village, Inc. (WWV) leaders or its contracted agents the right to represent me in decisions relating to my welfare or the group welfare during the trip. I will follow the suggestions made on my behalf.
  5. WWV will provide me with emergency medical or accident insurance covering injuries and illnesses I may sustain or experience overseas, and more specifically in Haiti or any other country in which I will be living and/or traveling while working with WWV. I hereby absolve and release WWV from all responsibility and liability for any injuries, illnesses, claims, damages, charges, bills and/or expenses I may incur while I am abroad.
  6. I attest and certify that I am physically fit and have no medical conditions that would prevent me from performing my assigned duties which may include long hikes, high altitude, heat, limited and infrequent meals. I am aware of the disease risks associated with foreign travel and I accept these risks. I agree to report to WWV any physical and/or mental condition I have which may require special medical attention or accommodation during my stay at least thirty (30) days prior to departure on each trip.
  7. WWV reserves the right to decline at any time allowing me to continue with any trip, including if WWV determines that my actions, conduct or general behavior are inappropriate or negative with respect to the spirit of a trip or the rights or welfare of any person or that they violate any rule, policy or procedure of each trip. WWV reserves the right to cancel any trip or any aspect thereof at any time prior to departure and after departure, requiring that all participants return to the United States. While I am in Haiti, I will abide by the rules, policies and procedures set out by WWV, including those related to curfews, travel outside the Program’s location in Haiti, and the use of public transportation and medical facilities within Haiti.
  8. I hereby release and forever discharge WWV and their employees, agents, officers, directors and representatives (in their official and individual capacities) from any and all liability whatsoever for any and all claims, damages, losses or injuries (including death) I sustain to my person or property or both, including but not limited to any claims, demands, actions, causes of action, judgments, damages, expenses and costs, including attorney’s fees, which arise out of, result from, occur during or are connected in any manner with my participation on each trip to Haiti.
  9. I am entering into this Waiver and Release Agreement and agreeing to all of its terms and conditions on behalf of myself and my heirs, personal representatives, successors and assigns.
  10. I hereby agree that this agreement shall be governed only by the laws of the State of Minnesota. Venue for any action hereunder shall be in Ramsey County, of the State of Minnesota.
  11. As a World Wide Village volunteer, I grant World Wide Village permission to use photos and video submitted to WWV or in which I may appear, blogs, electronic media comments, and trip evaluation comments in publications, web pages, brochures and press releases in order to continue promotion of World Wide Village and the overall programs. Please inform us by phone or email if you do not grant us permission.
  12. In signing this Waiver and Release Agreement, I hereby acknowledge that I have read this entire document, that I understand and agree to and will abide by its terms and conditions, and that I understand I am giving up substantial legal rights I may otherwise have and have done so knowingly and voluntarily.

I have read and agreed to the Terms of Service

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