2023 Enrollment Form Educator Academy in the Amazon Participant InformationName* First Last Name Tag*Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* School/Organization:*Cohort Preference* Elementary (K-5) Middle School (6-8) High School Informal EducationSubject/Courses you teach*Will you be applying for a scholarship?* Yes - through the Morpho Institute. Yes - through a third party. Not at this time.How did you hear about us?* Word of mouth Search Engine Social Media (Facebook, Instagram, Twitter, etc.) Email Are there any other notes or considerations we should know?Terms and ConditionsAcknowledgment* I have read and agree to comply with the following Terms and ConditionsMORPHO INSTITUTE TERMS AND CONDITIONS PLEASE NOTE: An electronic transmission (PDF or otherwise) of this document shall be the same as delivery of the original. Registration: Reservations are accepted on a first-come, first-served basis. You will be notified of acceptance within 24 hours of submission. Your space on the roster will be confirmed upon receipt of this Enrollment Form and a $125 nonrefundable deposit to the Morpho Institute. Limitation of Liability: The Morpho Institute disclaims all liability for property loss or damage and/or any other damages, loss, or claims resulting from death, illness (including but not limited to COVID-19) or personal injuries, including loss of services which may be sustained on account of, or arising out of, by reason of, in connection with, or while engaged on any trip, automobile, boat, vehicle, horseback, canopy riggings, inn, common carrier, aircraft, interaction with other participants, instructors, or third parties, or otherwise caused by, arising out of or in connection with any failure, delay, due to any cause whatsoever occurring during a tour under its management, sponsorship, suggestion, procurement or otherwise. The Morpho Institute contracts with EcoTeach, who in turn contracts with service providers for transportation, hotels, meals, guides and tours. EcoTeach may have its own policies, procedures, and requirements relating to COVID-19 which could require you to be vaccinated, wear a mask, undergo testing for COVID-19, or other requirements. These services are not under the Morpho Institute’s control. The Morpho Institute is not liable for any delays, inconveniences, accidents, expense or mishap of any kind whatsoever resulting entirely, or in part, from the negligence or actions of others or from causes beyond its reasonable control. The Morpho Institute does not accept any responsibility for losses or additional expenses due to delay or change in air services, sickness, weather, strike, war, quarantine, international or domestic travel requirements or restrictions issued by the United States, Peru, or any other country, or other causes beyond its reasonable control. All such losses or expenses will be borne by the participant. You agree that to the extent consistent with applicable law, the maximum amount of recovery to which you may be permitted to recover from Morpho Institute shall not exceed the Educator Academy Program Fee. To the maximum extent permitted under applicable law, the Morpho Institute shall not be liable for any special, consequential, indirect, incidental or other damages, including lost profits, whether such damages arise in contract, negligence, tort, under statute, in equity, at law, or otherwise, even if the Morpho Institute has been advised of the possibility of such damages. You expressly waive any right you may have to recover such damages. Cancellation: If you leave a tour in progress, for any reason, it will not result in a refund, and no refunds will be made for any unused portions of a tour, including those that are the result of your removal from a tour and for reasons related to weather, terrorism, civil strife, personal, family or medical emergencies or any other circumstances beyond our control. Services Provided: The Educator Academy Program Fee includes: program administration fees, program resource kit, postage for resource kit, six-week online pre-departure coursework and webinars, access to private on-line network for program participants, and donations to support our indigenous community partners in the Amazon. Costs not included in the Educator Academy Program Fee include: COVID-19 testing, ground transportation, accommodations, hotels, naturalist/guides, meals and activities, departure taxes, tips for guides and drivers, additional equipment rentals, specified optional activities and expenses of a personal nature. If a trip must be extended or an itinerary modified due to safety, weather, road conditions, lack of transportation, political or civil disputes, medical emergency or other causes beyond our reasonable control, all associated costs including any non-recoverable costs are not included in the trip rates or refunds. Medical Treatment/Medical Proxy/Release: Participant gives the Morpho Institute and their contractors permission to arrange emergency medical treatment for participants if deemed necessary in the Morpho Institute’s sole discretion, and Participant agrees to hold the Morpho Institute harmless for the provision or non-provision of such services, and waives any and all claims for injury, illness or death arising from or related to this proxy other than those claims arising from the Morpho Institute’s willful misconduct or gross negligence. Participants agree that neither they, nor any of their heirs, personal or legal representatives, or family members will bring suit or make a claim for illness, injury, loss or damage to property, or loss of life resulting from the negligence (but not the willful misconduct or fraudulent misconduct) of the Morpho Institute, its employees, directors, owners, officers, agents, contractors or affiliated organizations as a result of my participation in this trip. Participants also agree that they knowingly waive any and all claims of any nature they may have against the Morpho Institute other than those arising solely from Morpho Institute’s willful misconduct or fraudulent misconduct. Photo and Media Release: Participants are often included in photos and other media we create during our trips or that are shared with us by other participants. Our purpose is to produce educational and outreach materials associated with the subject matter of our programs. By signing this Enrollment Form you are granting permission for discretionary use of your picture, recording, writing, or projects to be used in our educational resources, website, Facebook, YouTube, Instagram, or other printed or electronic information related to our programs all without compensation to you. If you have questions or concerns regarding this release, or would prefer not to grant permission for use of your image, you will need to contact the Morpho Institute directly at (913) 214-6126 or via email at email@example.com prior to your departure. Responsibility: Participants are expected to conduct themselves in an orderly and acceptable manner and not to disrupt the enjoyment of other participants. If in our opinion or in the opinion of any person in authority, your behavior is causing or is likely to cause distress, danger or annoyance to any of our other guests or any third party or damage to property, or to cause a delay or diversion, we reserve the right to terminate your participation immediately. In the event of such termination, our liability to you will cease and you will be required to leave the trip immediately. We will have no further obligations to you. No refunds for lost services will be made and we will not pay any expenses or costs incurred as a result of termination. You may also be required to pay for loss and/or damage caused by your actions and we will hold you individually liable for any damage or losses caused by you. Full payment for any such damage or losses must be paid directly to the supplier prior to the conclusion of the trip. If you fail to make payment, you will be responsible for meeting any claims (including legal costs) subsequently made against us as a result of your actions together with all costs we incur in pursuing any claim against you. We cannot be held responsible for the actions or behavior of other guests or individuals who have no connection with your trip or with us. Participants will be returned to their country of departure, at their expense, upon such termination. Immunizations / Health: The Center for Disease Control and Prevention (CDC) provides information on required and recommended vaccines and immunizations for international travel: http://wwwnc.cdc.gov/travel/destinations/list. The CDC website also offers advice on reducing risks associated with mosquitoes, sand flies, and other insect-borne illnesses and bite and provides recommendations on the use of insect repellent (http://wwwnc.cdc.gov/travel/page/avoid-bug-bites and http://www.cdc.gov/westnile/faq/repellent.html). By making a deposit with Morpho Institute or signing this form you certify that you have reviewed the CDC’s information regarding these issues. Warnings: It is your sole responsibility to ensure that you are healthy and fit enough to participate in the tour. Good physical and mental health are essential for the enjoyment of these active adventure trips. You may travel in rugged areas far removed from modern medical facilities. Good physical conditioning is recommended as preparation for all trips. By forwarding the deposit and/or this signed Enrollment Form, you certify that you do not have any physical or other conditions that would create a hazard for yourself or other travelers or affect other people’s enjoyment of the tour. It is essential that any participant with a medical condition requiring regular or special treatment or which may be affected by vigorous activity, high altitude, heat, cold, other natural phenomenon, or particular foods, notifies the Morpho Institute in advance of travel. We suggest that you consult with your personal physician if you have any health-related problems, concerns or questions. Although the Morpho Institute stresses safety in all aspects of its program, PLEASE BE AWARE that travel of any type, and participation in the real and exciting activities of eco-tourism and cross-cultural studies, can be inherently dangerous and always involves the risk of serious injury, illness or death.Acknowledgment* I have read the current COVID travel requirements and understand they are subject to change. I agree that it is my responsibility to monitor and comply with the policies of the U.S. Embassy in Peru and the U.S. Department of State up until the date of departure.COVID TRAVEL REQUIREMENTS AND DOCUMENTATION It is the participant’s responsibility to ensure they carry proper and valid documentation. US Citizens should review International Travel Information available from the US Department of State at www.travel.state.gov for entry requirements. Citizens of countries other than the United States should check with the Embassies of the countries on their itinerary. As of this writing (September 2022), all air travelers, including United States citizens, must present proof of being fully vaccinated 14 days prior to boarding at their point of origin. United States citizens and lawful permanent residents who are unable to show that they are fully vaccinated will have to show documentation of a negative viral test taken no more than one day before boarding any flight in the United States with an ultimate destination in Peru, and before boarding any flight in Peru with an ultimate destination in the United States. All passengers older than 45 years of age using commercial transportation to travel between provinces by land must present proof of vaccination to travel. These requirements are subject to change. The U.S. Embassy in Peru provides up-to-date information regarding vaccine and testing requirements for travel between the United States and Peru: https://pe.usembassy.gov/covid-19-information/ The Morpho Institute will not issue refunds or be liable for any loss or damage arising out of or in connection with your inability to participate in any or all aspects of the program due to your COVID-19 vaccination status. The U.S. Embassy provides contact information for labs within Peru that offer testing services. The Morpho Institute cannot guarantee the availability, accuracy, or quality of services any testing laboratory may provide, and bears no responsibility for any lack of availability of testing or any other claim or cause of action arising out of or relating to your COVID-19 testing in Peru. By making a deposit with the Morpho Institute or signing this form you certify that you have reviewed the policies of the U.S. Embassy in Peru, and the U.S. Department of State policies available here: https://travel.state.gov/content/travel/en/international-travel/emergencies/covid-19-faqs-for-travel-to-the-us-information.html and that you will continue to monitor the policies of the U.S. Embassy in Peru and the U.S. Department of State up until the date of your departure.Acknowledgement* I acknowledge and understand:1) The Morpho Institute requires participants to be fully vaccinated for COVID-19. 2) Payment of the non-refundable the Morpho Institute Program Deposit of $125 and this enrollment form together secure my place in the Educator Academy in the Amazon. 3) The balance of the the Morpho Institute Program fee is due no later than May 1, 2023. 4) This enrollment form will be shared with our travel partner EcoTeach. To finalize my enrollment, I must complete an EcoTeach Registration Form and Terms and Conditions. 5) All payments for in-country land costs will be made to EcoTeach and my participation in the Educator Academy is subject to their payment schedule, cancelation policies, and terms and conditions. 6) I will receive communication from both the Morpho Institute and EcoTeach related to the Educator Academy.Signature*Date* MM slash DD slash YYYY CAPTCHACommentsThis field is for validation purposes and should be left unchanged.