Non-U.S. or Malawian Volunteer or Hired Staff - Information and Statement of Purpose and Acknowledgment

Volunteer Name:

First Name

Last Name

Country or Nationality

Group or Organization

Email:

Have you worked with children before and if so, in what capacity?

If non-U.S., non-Malawian, state your purpose for visiting Malawi and specific purpose for visiting Kusewera Village

If Malawian, list your home village, city, district, chief of that village (phone # if applicable) and the last place of residence

State your purpose for visiting Kusewera Village and list your skills, expertise, education & employment history pertaining to the desired volunteer or hired work

I have read and signed the general Kusewera policies and guidelines and agree to comply in full.
YesNo

In addition, as child safety is of the utmost importance, I understand that no Kusewera staff member, volunteer or outside worker coming to Kusewera Village shall be alone with a child unless they are the parent, legal guardian or approved guardian of that child. Two adults should always be present and/or two children present with the adult staff or volunteer.

Any child or adult who is uncomfortable being alone with anyone else (child or adult) should let the discomfort be known to another adult Kusewera representative or staff member without shame or fear.

I understand that Kusewera will not tolerate emotional, psychological, or physical abuse of any kind, especially against any children participating in our programs or against volunteers, staff and anyone else affected by the presence of Kusewera and its programs.

I affirm that I do not have any history or record of abuse of others, either physically or emotionally and that I do not have a police record of any kind in Malawi or anywhere in the world.

I understand that if the policies and guidelines set forth are not followed, Kusewera reserves the right to end my involvement with Kusewera and at Kusewera Village immediately. If any actions are deemed unacceptable or punishable by law, Kusewera will take full action against me at my own risk.

Volunteer Signature

Date

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above terms and policies.

I affirm that I do not have any history or record of abuse of others, either physically or emotionally. I verify that the information provided is true and to the best of my knowledge. I understand that misrepresentation of this information will constitute grounds to terminate participation on a Kusewera trip.