Visitor Health & Safety Form

Note: Please allow 20-30 minutes to read and complete this form in its entirety. Before filling out this form, you will need to have purchased your international flights.

Contact Information

Emergency Contact Information

Travel Information

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Health Information

Participant Release and Waiver of Liability

Acknowledgement of Receipt of Visitor Guide

Visitor Code of Conduct

As a visitor to Indonesia, I understand that I am a guest and that my actions represent others' perceptions of not only me - but the reputation of my country/nationality, my institution, Health In Harmony, and the local partner organization, ASRI. I agree to participate and act in a respectful and responsible manner. I understand that Health In Harmony and/or ASRI will attempt to give two warnings, and then I may be asked to leave the site at my own expense. Depending on the severity of the infraction, I understand that I may be asked to leave right away. Please note that being asked to leave is extremely rare but we want to make sure we are clear with you about our expectations for your behavior.

I will abide by the laws of the country I am visiting and will be respectful of the hosts and the partner organization.

I will participate or engage in the agreed-upon project or program schedule.

I will refrain from smoking and from using illegal drugs.

I will limit (or abstain from altogether) my alcohol intake so as not to impair my judgment and/or impact my ability to function as a responsible group member. I will never be visibly intoxicated.

I will adhere to the guidelines and cultural norms regarding dress, as outlined in the Visitor Guide.

I will treat program facilitators, ASRI staff, and community members with respect. I will not speak in a manner that is rude, offensive, or aggressive.

I will not be violent or participate in any violent act or activity.

I will not act in a way that will put myself or others in danger.

I will refrain from co-habitating with my partner if I am a member of an unmarried couple. I will also refrain from public displays of affection.

I will be flexible, as I understand that I am not in my home country/culture, and that not everything will go as I may want, or as according to plan.

I will be aware and respectful in the way I take photographs. I will seek permission, when possible, to take someone’s photo.