BALI-form <- PRINT OUT AND FILL IN FORM

BALI – SPIRIT AND NATURE DANCING TOGETHER

ADDITIONAL NOTES

Please return these signed document regarding TRAVEL DOCUMENTATION
MEDICAL INFORMATION
DIETARY NEEDS

ASSUMPTION OF RISK AND RELEASE OF LIABILITY

by either e-mail or post to Heart of the Jungle, Inc.
as soon as you can no later than March 1, 2013
Heart of the Jungle, Inc. PO Box 1567, Makawao, HI 96768, USA E-mail Balispirit2013@yahoo.com

Airline reservations made sooner than later to secure your best price on Round trip to Denpasar, Bail, Indonesia (Name of airport you land) is advisable. The balance of your payment is due no later than Feb 28, 2013 by certified check, money order or bank transfer in US Dollars.

Please make checks out to Heart of the Jungle Send to PO Box 1567 Makawao, HI 96768.
Please be sure that it is sent in a way that we are able to sign for it, for your protection.

Everyone must present a valid credit card as they register at the front desk. Your credit card will only be charged for incidentals or any extras you may decide to purchase during your stay.

The group price is for March 30 arrival date thru April 13, 2013 at noon retreat ends.

All lodging etc. before that and after April 13, 2013 will be on your own.

Please Contact Solomon if you are coming earlier or staying later for Him to make arrangements for you.

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Name Passport No. Nationality Expiry Date

__________________________________ __________________________________ __________________________________ __________________________________

Departure City Departure Date Airline/ Flight No. Arrival Date /Time Return Date Return Flight Time

__________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________

TRAVEL DOCUMENTATION

Expiry Date MUST READ at least Oct 30, 2013. Please check your passports prior to travel.

BALI – SPIRIT AND NATURE DANCING TOGETHER – ADDITIONAL INFORMATION

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MEDICAL INFORMATION

Doctor’s Name _________________________________________ Phone _________________________________________

Are you taking any special medications? If so, what? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

Do you have any allergies? If so, what? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

Do you have impaired vision? Glasses or contacts? __________________________________________________________

Do you have physical impairments or disability? If so, explain. ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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DIETARY NEEDS

It is important to know your dietary needs so that we can communicate with our hotel and restaurants. Please be as detailed as you can be if you are on a special diet.
Do you have any FOOD allergies or are you on a special diet?

Please Explain. ________________________________________ __________________________________________________________ __________________________________________________________

______
______
______
______
______
______
______

Vegetarian (Dairy & Eggs OK) Vegan (No Animal Products)
I Eat Everything and Love it All Sensitive to Spicy Foods Chicken OK / NO
Seafood OK / NO
Red Meat OK / NO

Do you have any other special needs you would like to share with us? If so, please explain. ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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ASSUMPTION OF RISK AND RELEASE OF LIABILITY

I do hereby agree to take complete and total responsibility for my actions on the “BALI – SPIRIT AND NATURE DANCING TOGETHER“ from March 31 – April 13, 2013.

I hereby agree to release and discharge Mariam Baker, A. Solomon Sikirdji (tour guide), Michael Ali Stoeckel or any representative of Heart of the Jungle, Inc, on behalf of myself, my children, my parents, my spouses, my immediate and extended family, my heirs, assigns, personal representatives and estate, as follows:

I acknowledge that there are known and unanticipated risks which could result in physical and/or emotional injury, paralysis, death or damage to myself.

The risks include, among other things, slipping and falling, falling rocks, water hazards, high altitudes, other people’s negligence or my own negligence.

I expressly agree and promise to accept and assume all risks existing in, or arising during this event. I hereby take complete and total responsibility for my actions during this event and release Heart of the Jungle, Inc. from any and all claims of liability arising from this event.

I certify that I am in good health (both physically and emotionally) and capable of participating in this event. I understand that it is solely my responsibility to determine whether there is any medical reason that I should not participate in this event or any activity of this event. I understand this event will include some hiking on unmaintained trails. I also understand that all activities in this event are voluntary, and I reserve my right to refuse to participate in activities that may endanger my good health or that are beyond my capabilities (either physically or emotionally).

I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless Heart of the Jungle,Inc., its directors, officers and shareholders, and Mariam Baker and Michael Ali Stoeckel, from any and all claims, demands or causes of action, whether from bodily injury, loss, or otherwise, which are connected with my participation in the “BALI – SPIRIT AND NATURE DANCING TOGETHER“. This includes any claims which allege negligent acts of omissions by Heart of the Jungle, Inc.

I acknowledge with certainty that I have had sufficient opportunity to read this entire document. Signature ________________________________________________________________________ Print Name ________________________________________________________________________ Street Address ________________________________________________________________________ City __________________________ State _________________________ Zip _________________ Phone _______________________________
IN CASE OF EMERGENCY CONTACT: Name ________________________________________ Phone (home) _____________________________ (cell) _____________________________________ MEDICAL CONDITIONS HEART OF JUNGLE, INC. TO BE AWARE OF: _____________________ _____________________________________________________________________________________

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BALI – SPIRIT AND NATURE DANCING TOGETHER

Important Things to Consider:

PASSPORT – Must be valid for 6 months PAST your exit of Indonesia. Oct 30,2013 at least. Make two copies, one for safekeeping and one to give to us upon arrival.

BAGGAGE ‐ Please check with your airlines prior to departure regarding their baggage restrictions. Many airlines are now allowing only one bag per passenger and extra charges for additional bags. Check with your airlines and plan accordingly. Additionally, you may want to pack a collapsible duffle bag to fill with your purchases and carry home.

RETURN TICKET – You must show customs your return ticket upon arrival to Bali. Please make sure you have it with you or at least a copy of your e‐ticket.

VISA – You will need $25 cash when going through customs to purchase your visa. Please keep $25 in your passport holder. This visa is good for 30 days. If you are planning to stay longer than 30 days please contact us at your earliest convenience for further instructions.

MONEY – You will get a lower rate of return with Traveler’s Checks. The best rate of return would be in the form of $100 dollar bills. You must ask your bank for the newest ones, “F” or “H” series; if your bank asks you why you need this specific series, simply state you are travelling to Indonesia and these bills get the best conversion rate. If you end up with older series bills, your rate will be much lower and you cannot change them at just any place. We will help you change them, it is just not as convenient as “F” or “H”series bills.

Cash is easiest in Bali and the hotel will provide a safe.
Average spending money per day, without purchases, is about $30 US per day. Of course, if you plan to shop or visit the spa you will need more.
At the present time, $1US is equivalent to 9,000 Indonesian Rupiahs. The rate fluctuates daily. Cash in Euros is fine larger denominations get better rate 1 Euro equals approximately 12,160 Rps To see what your money is worth in Indonesia you may visit any online currency conversion site such as www.xe.com/ucc

WEATHER CONDITION – Bali is in the tropics. Please pack accordingly. It is very warm during the day (around 80 degrees) and can get cooler at night (between 50 – 60). You will want a light cover‐up, umbrella and lightweight long pants to protect you from mosquitoes or the sun. Shorts and tank tops are acceptable most anywhere except Temples. Any type of clothing is available in Ubud, so you may always shop if you forget something.

DRINKING WATER – We will provide a 5‐gallon container of pure drinking water available for refilling your water bottles. Do not put water in your mouth while showering, brushing your teeth or swimming. Use only bottled water for anything you need.

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TEMPLE VISITS – Please note that for special ceremony or temple visits, covered shoulders are required of both men and women. We will provide 2 sarongs and sashes for these visits. Men should wear a light dress shirt and women are required to wear sleeves – NO tank tops allowed in temples. (You may want to buy others.)

SHOPPING – There are a variety of stores in Ubud and you can find most anything. Please note that western type sunscreen and medications are very expensive. You may also find what you need among your fellow group members if you forget something.
You might consider purchasing a book about Bali from Lonely Planet to familiarize yourself with local customs and all small details.

Here is a checklist for your convenience:

Bathing Suit
Travel towel
Small backpack, daypack or fanny pack for our daytrips
Sunhat or visor
Sunscreen
Comfortable walking shoes or sandals
Compact Umbrella
Warm long sleeve for night time (maybe just the one you wear on the plane)
Bring a shawl, a sweater, sometimes it you may get chilly indoor air‐conditioned restaurants. Please bring one or two white blouses with some sort of sleeve.
Toiletries you need including contact lens supplies
Medications (including some diarrhea pills in case of “bali belly”)
Homeopathic remedies such as Traumeel or Rescue Remedy crème,

which can be used on bug bites
Healthy Snacks (if you just can’t live without your power bars or whatnot)
Tea you enjoy (only black tea is available most places)
Camera
Batteries if you need them
Power converter, if you need it, and two‐pin plug converter for 220 volts
Antiseptic wipes
Insect repellent
Nalgene‐type water bottle for refilling and sparing the environment
Flashlight (something you can carry with you, streets are not always well‐lit)
Internet is widely available and wireless is also available, you may bring your laptop

if you so desire
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