Application to Intern in Costa Rica

Please fill out the form to the best of your ability. Honesty is certainly the best policy in this regard, as it will help us to know you better. Depending on your answers we may have more questions.

There is a non-refundable processing fee of $75 which you can add to your shopping cart after you complete this application. Once your application has been reviewed we will get in touch with you. Thank you for your interest in joining us in Costa Rica.

Terms and Conditions: Due to the sensitive nature of this event, interns may be asked to leave if they are becoming a disruption to the group. If such a situation is to occur, which is at the sole discretion of Dr. Douglas Graham, and an intern cannot follow the rules and regulations set forth by Dr. Graham and his staff, which results in that intern being asked to leave they will not be entitled to a refund of their expense. By completing this form you are accepting these terms.

Questionnaire

Event

Costa Rica Internship: (these dates are provisional) December 31st - February 6th, 2011 :

Personal information

Name:
Address:
Phone number:
Email:
Age:
Gender:
Male:
Female:
Relationship status:
Occupation:
Job title:

Brief History

How did you hear about the internship?
Why are you interested in joining the intern program?
What do you hope to get out of the program? Or what are your future intentions with the education you receive with this program?
What is your educational background, including personal studies?
What are your hobbies and interests?
Do you have any kitchen/restaurant skills or interest in learning how to work in/run a kitchen?
What do you expect to learn about fasting?
Do you have any experience with fasting?
Do you have any health concerns you are challenged by?
Do you have any experience in equatorial/tropical climates?
Are you able to put in a full day's effort?
How would you describe your interpersonal skills?
What would you describe as your greatest strength?
What would you describe as your greatest weakness?
Are you familiar with Dr. Graham's program 80/10/10? If so, how long have you known about it and do you follow it?
Which of Dr. Graham's educational books, CDs and DVDs do you own?
How did you hear of Dr Graham/FoodnSport?
Is there any information you feel is vital for me to know about you, or anything you want to add?

Assumption of Risk, Release, Waiver of Liability, and Covenant Not to Sue

PART I: ASSUMPTION OF RISK

I intend to participate in a program entitled Fasting Internship in Costa Rica, a retreat from in San Gerardo, Costa Rica (hereafter "Fasting CR") conducted by Dr. Douglas Graham, and his staff (hereafter the "Graham Group") in association with Rio Chirripo Retreat Center, Staff and Frank Faiella, Owner (hereafter "Rio Chirripo"), and I acknowledge that participation in any lifestyle program may involve inherent risks of physical injury, possibly including, but not limited to, broken bones, strains, sprains, bruises, concussion, heat-related illnesses (hyperthermia), abnormal heart beats, abnormal blood pressure, drowning, and in rare cases, a heart attack, stroke, and possibly death.

I further acknowledge that I am solely responsible for any hospital or other costs arising out of any bodily injury or property damage sustained through my participation at Fasting CR.

I have read and understand this notice. By signing this form, I accept and assume all risks, hazards, and dangers - known and unknown, foreseeable and unforeseeable - involved in any such activities in which I may elect to participate at Fasting CR, including the training for, preparation for, residing within, and travel to and from the sites of such activities.

PART II: RELEASE, WAIVER OF LIABILITY, AND COVENANT NOT TO SUE

For myself, my heirs, executors, administrators, and assigns, I agree - for the additional consideration of the enrichment I expect to derive from the Fasting CR program and for the consideration of the Graham Group allowing my participation in the program - to waive, release, hold harmless, covenant not to sue, and forever discharge the Graham Group and/or Rio Chirripo, and their members and entities individually, their officers, agents and employees and staff, from any and all claims, demands, rights, causes of action, judgements costs and expenses, or other liability of whatsoever kind or nature, including gross negligence of the releasees and/or others, resulting from my participation in or growing out of or in any way connected with Fasting CR either arising before, during and/or subsequent, including but not limited to any and all, known and unknown, foreseen and unforeseen, bodily and personal injuries, including death and its consequences.

I hereby certify that I am at least 18 years of age, or am represented by a parent or guardian, that I am suffering under no legal disabilities, and that I read this form carefully, understand it, and agree to be bound by its terms. I also acknowledge that I have asked a member of the Graham Group all questions that I have concerning this document, if any, and, if so, that my questions have been answered satisfactorily.

I also agree that any audio or video recordings or written notes I capture during this event are for my own personal use, and will not be put to any commercial use, whether or not a fee is charged.

I agree to these terms:
Please supply contact information in case of emergency:
Name:
Phone:
Email: