Building Better Lives Together  

  Quick Contact:
 

Name:*
Email:*
Message*
Enter the code shown:*
This is a CAPTCHA Image 
 
(*) Mandatory field
 

 

Global Tribe Logo

Mexico Building Trips in Partnership with Global Tribe

 

Cambodia Building Trips in Partnership with Tabitha Foundation
 

Uganda  Trips in Partnership with TEAR Fund &

Watoto

Peru Trips in conjunction with Fuller Centre of Housing

 
 Russia Trips in Partnership with Orphans Aid International

 

Visit our Facebook Page

Download our 2017 Brochure

2017 Brochure

 

 

UG1801

UG1801 Watoto Childrens Village - Departs 30th December 2017 from New Zealand

The name you use below must match the name in your passport

First Name*
Last Name*
Preferred Name
House Number & Street Name
Suburb
City
Post Code

Updates are sent via email, please ensure you whitelist info@breakfreeexpeditions.com. Please click here if you need further assistance.

Email Address*
Home Phone
Work Phone
Cell Phone
DOB - Day*
DOB - Month*
DOB - Year*
Gender
Male  Female 
Occupation
I have a valid passport
Yes  No 

Your passport must be machine readable and be valid for 6 months after arrival back in New Zealand.

Passport Number
Expiry Date
reset
Nationality
Freq Flier #
Special Dietary Requirements

255 characters left
Meeting Point*
Auckland Airport Monday 1st January 2018
Dubai Stopover
I am departing from

If you decide to join us at our stopover point before we get to Entebbe we can arrange accommodation with our team for you.  Please contact us for rooming costs and more details

Return Date - arrives NZ
Sunday 21st January 2018  Other - Specify Below 
Other Return Date
reset
Other Return Date Comments

255 characters left
Accomodation
Single Room (additional cost)  Share Twin 
Preferred Roommate

If you are coming with a group, please provide the following details (skip this if you are coming as an individual)

Group Name


Please indicate if you are a:

Doctor, Nurse, Trained First Aid Officer

Please complete the following if you are under 18yrs otherwise skip to the next section.

Parent/Guardian Last Name
Parent/Guardian First Name
Parent/Guardian Email
Parent/Guardian Phone
Trip Guardian Last Name
Trip Guardian First Name
Trip Guardian Email
Trip Guardian Phone


Please indicate if you have any criminal convictions and/or communicable diseases and enter dates and details in the box provided. Click
here for an overview of the NZ Government's Pay or Stay requirments.

Criminal Conviction
Communicable Disease
Dates and Details

255 characters left
This question is compulsory to answer otherwise the form will not submit.  Please specify any pre existing medical conditions that you may have (eg asthma, heart disease, food allergies, diabetes, mental illness etc).  Please list what medications you take on a regular basis to control these conditions. If you do not have a pre existing condition please put NIL into the box below.  Failure to disclose may this information could mean you are excluded from the trip at a later stage with all monies paid forfeit.  Thanks for your co-operation with this.
Pre existing medical condition details

255 characters left


Please provide details of someone we can contact in an emergency.

Emergency Contact*
Phone*
Email Address
T shirt Size
Please indicate which Optional Excursions (additional cost) that you may be interested in participating in.  You can change your optional excursion selection up to one month prior to departure. 
Uganda Safari - 3 days (approx US$595-$640)
Uganda - White Water Raft the Nile (approx US$125)
Uganda - Fishing on Lake Victoria (approx US$95)
Dubai - City Tour (approx NZ$40)
Dubai - Desert Dune Safari (approx NZ$70)
How did you find out about this trip?
By checking the "I Agree" box directly above and submitting this form I acknowledge that I have read, understand and agree to all terms, conditions and agreements contained in the agreement herein. Click here to view the Agreement.
I Agree*

To secure your booking a non-refundable deposit of NZ$300 is due immediately. The balance is due no later than 1 September 2017. Click here for payment options.

Promotion Code (if any)
Once you have completed this form please click SUBMIT.  You will be redirected to a payment methods page which will give you the details of where to pay your trip deposit.  If your computer shows you a blank page after you have hit submit your form has not been received by us.  Please go to Tools on your internet menu and delete your browsing history and/or temporary internet files.  Click the Trip Code on the Trips page and click the RESET button at the bottom of the form before re-completing your registration.  Please contact us if you have any problems with submitting this form.  You should receive an email from us within 48 hours confirming your trip registration.
Enter the code shown:*
This is a CAPTCHA Image 
 
(*) Mandatory field