• 0161 870 6212
  • 1.413.517.0266

Medical Questionnaire

Please complete this questionnaire as soon as you are able; it is for your own safety that we find out as much as possible about your medical history and to ensure that you can cope with the rigours of the project.

Because traveling overseas can be both physically and emotionally demanding, we ask that you provide an honest evaluation of your health. A certain amount of stress due to culture shock or the change in living conditions and facilities is a normal part of the experience. However, in some cases, such stress may aggravate disabilities or an illness to which you have control of at home.

With this form, we hope to create an awareness of health issues that you should take into consideration before going abroad. This information will be used primarily to guide us in making appropriate arrangements for you as a Kaya participant and will be forwarded to our in-country directors.

All your answers will be treated in the strictest confidence and will not necessarily adversely affect your chance to take part.

We will attempt to accomodate everybody, but do reserve the right to refuse participation on medical grounds if we feel your safety, or that of the group, may be compromised. Any decision made will be in consultation with you and your doctor. Should any of your medical details change after you have completed this form then you must inform us and failure to do so may invalidate your insurance or affect your participation in the program.

Please note that failure to disclose correct medical information with your booking may result in the termination of your volunteer program should these inaccuracies come to light.

  • Your Personal Details

  • Travel Insurance Provider

    PLEASE NOTE: for US volunteers your regular Health Insurance is very unlikely to cover you for health care abroad. If you are from the US, please contact your insurance provider and ask them whether you will be covered for emergency health care whilst on your project. If you aren't covered, please arrange an alternative travel insurance policy and supply us with these details.
  • Medical History

  • Disclosure

  • By checking the box above I verify that I have disclosed all necessary health information and that all information above is true and accurate to the best of my knowledge. I understand that failure to fully disclose any health may result in my removal from the Kaya programmes.


Our experienced placement advisors are here to help. Feel free to reach out if you have any questions.

UK Office

Open Mon-Fri, 8am – 6pm (GMT)

Calling from UK: 0161 870 6212
International: +44 161 870 6212

Kaya Responsible Travel,
91 Princess St
M1 4HT, UK

USA Office

Open Mon-Fri, 8am – 6pm (EST)

Calling from USA: 1 413 517 0266
International: 1 413 517 0266

Kaya Responsible Travel,
3015 East Franklin Ave
Minneapolis, 55406