Summer 2021 NEW Service Year Participant Registration. This form is for participants who are not currently enrolled in the service year to join for the summer of 2021 international trips. If you are a current Youthlincer looking to complete your postponement decision form, please CLICK HERE Please enable JavaScript in your browser to complete this form.International Preference - Step 1 of 10Indicate your first choice of international site: *JamaicaKenyaNepalCosta RicaPeruIndicate your second choice of international site: *JamaicaKenyaNepalCosta RicaPeruIndicate your third choice of international site: *JamaicaKenyaNepalCosta RicaPeruTravel month placement (this may affect international site placement): *JuneJulyAugustCheck all that applyAre you hoping to travel with another Youthlinc applicant? If so, what is the name of the individual? Keep in mind in order to be selected to travel together, BOTH parties must list each other. Please do not list more than 2 people.NextAre you applying as a mentor, alum leader, or humanitarian?Mentor (24+)Alum Leader (Has participated in the Service Year Before)Humanitarian (First Year Participant 16-24)Alum Leader Previous Team *Alum Leaders have been on a previous team, please indicate the year and site of your past Youthlinc experience.Name *FirstMiddleLastAs it appears (or will appear) on passport. If you do not have a passport at this time, you can still apply and get your passport later. Your name must be entered as it appears on your passport. This name will be used to purchase your flight.Cell phone number (include area code): *Applicants e-mail address: *EmailConfirm EmailNo school emails please.Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeGender as stated on passport *MaleFemaleBirthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age at time of trip departure: *(make your best assumption - trips leave in June, July, and August)T-shirt size: *XSSMLXLXXLMen's sizesApplicant's Country of Citizenship: *Passport Number: *If you do not have one, put 0.Passport Expiration DatePreviousNextBeneficiary name: *FirstLastFor insurance purposes - usually spouse or parent. Beneficiary's email address: *EmailConfirm EmailBeneficiary's phone *Name of emergency contact: *FirstLastEmergency contact's relationhsip to you: *Emergency contact's e-mail address: *EmailConfirm EmailEmergency contact's phone number: *PreviousNextParent 1MotherFatherGuardianParent 1 name: *FirstLastParent 1 email: *EmailConfirm EmailParent 1 cell phone: *Parent 1 address:Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIf different than applicant's.Parent 1 place of employment: *Parent 1 job title/position: *Parent 2MotherFatherGuardianNot ApplicableParent 2 name: *FirstLastParent 2 email: *EmailConfirm EmailParent 2 cell phone: *Parent 2 address:Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIf different than applicant's.Parent 2 place of employment: *Parent 2 job title/position: *PreviousNextName of high school or college/university currently enrolled: *Indicate what year you are in school: *High school grade 10High school grade 11High school grade 12College FreshmanCollege SophomoreCollege JuniorCollege SeniorCollege/graduate students indicate if you are involved in any of the following (check all that apply):LEAPNursingSocial WorkRotaractOT/PTSpecial EdCumulative GPA: *Have you ever been involved with Rotary, Interact, Rotaract, RYLA, or Rotary International?If yes, please explain.List involvement in community service clubs/activities including start and end dates *List past/current employment including start and end dates: *Enter second language(s) and your level of proficiency if applicable:Are you applying for financial aid? *YesNoPreviousNextDo you volunteer currently? *YesNoNo, but I wish I was volunteeringIf yes, how often do you volunteer? *More than once per monthAt least once per monthAt least 2-4 times per monthOnce per year or lessI do not currently volunteerIf you do not currently volunteer or do not do so often, please tell us why.For example: not enough time, difficult to find service opportunities, etc. If you do volunteer currently, please tell us why.For example: class or club requirement, you enjoy helping others, etc. Where did you hear about the Youthlinc Service Year? (Check al that apply) *FamilyFriendTeacherPresentationInstagramFacebookParent heard about Youthlinc on FacebookInternet searchOtherYouthlinc referralDid someone currently enrolled or applying to Youthlinc refer you to apply? If yes, please state the name. PreviousNextRecommendation Contact #1 name: *FirstLastPlease designate the contact information for two people that know your skills and abilities. These people can not be family members. We suggest teachers, coaches, or service leaders.Recommendation Contact #1 phone: *Recommendation Contact #1 Email *Recommendation Contact #2 name: *FirstLastRecommendation Contact #2 phone: *Recommendation Contact #2 Email *PreviousNextPersonal Statement SubmissionText Box EntryFile UploadEmail to office@youthlinc.orgone page (maximum) single spaced, outlining the reasons for you interest in Youthlinc, what you believe you have to offer as a participant, what you expect to learn and experience while serving locally and globallyPersonal Statement Click or drag a file to this area to upload. Personal StatementPreviousNextI understand that I need to complete the required amount of local service hours before June 1st. *I understandLocal service is a critical element of our Service Year, essential to our mission of creating lifetime humanitarians. Student participants must select a main local service site and establish a schedule for volunteering at that site by the December team meeting, and contribute 60 hours of local service during the Service Year. Student participants are responsible for recording and verifying exact dates and times of their service hours with service supervisors in their Youthlinc online Local Service Directory account. I understand that I need to attend all team meetings. *I understandParticipants are responsible for following through on all Service Year requirements outlined in this document, participant manuals, team leadership emails, and in team meetings. Monthly team meeting attendance is mandatory, prepares participants for international service and leadership. Participants are responsible for committee assignments associated with the international service experience, which may include activities outside of monthly meeting times. It is the responsibility of each participant to contact Team Leaders and Youthlinc staff with questions or concerns. I understand that there is a $500 deposit to hold my spot on the team. *I understandBy December 1, a $500 non-refundable and non-transferable deposit is due from each participant. This deposit holds your spot on that team. Participants who do not make this deposit will be dropped from the program. An applicant from the waiting list will be invited to participate on the team. I understand the breakdown of International service experience costs. *I understandAt General Orientation for the Service Year, our International Service Director will distribute costs and payment schedules for each international service trip. These costs are inclusive of flights, all in-country transport, accommodations, food, water, major medical and travel insurance (does not include trip cancellation insurance), and Youthlinc program fees. Youthlinc negotiates the best possible airfare for the group, determined as early as possible in the Service Year. Program costs do not include any required travel documentation (e.g. passport, visa) or any recommended vaccinations. Participants are also responsible for their personal expenses in -country, such as toiletries, souvenirs, extra food or beverages other than water. Some students will apply for financial aid support for their international service trip costs. Recipients of financial aid will be notified by or before December. I understand the Youthlinc Refund Policy *I understandBy December 1, a $500 non-refundable and non-transferable deposit is due from each participant. This deposit holds your spot on that team. Participants who do not make this deposit will be dropped from the program. An applicant from the waiting list will be invited to participate on the team. If a participant drops from the program after any deposits, payments, or non-renegotiable contracts are made to coordinators or agencies facilitating our international service experience, including airlines, those deposits or payments are also not refundable. If a participant drops from the program 45 days or less from departure, all payments are non-refundable. Youthlinc reserves the right to cancel or postpone service trips, and change international service sites, at its sole discretion when it deems it necessary or advisable due to local conditions or world events. In the event of any such change, $500 deposits remain non-refundable. Youthlinc may also be required to forfeit nonrefundable payments for airfare and hotel deposits. Any such forfeiture will be charged against participant payments on an equitable basis, as determined by Youthlinc. In such cases, a participant who wishes to serve on an alternate or postponed service trip, or a service trip to an international service site that has been changed, would be required to make up the shortfall. In addition, as described above, amounts transferred to subsequent service trips will be reduced by an allocable portion of any forfeiture of deposits or payments that result from participant or Youthlinc initiated cancellations, postponements, or changes in response to world events or local conditions. Personal donations made which are matched by corporate giving programs are not eligible for refund up to the amount that was matched by the company. No unrestricted or general charitable donations are refundable under any circumstances. Any allowable refund must be requested by participants by June 1. No refunds will be issued until two weeks before departure. Any donations toward a participant’s international experience received after these deadlines will not be refundable, and will be allocated to project funds or sponsorships for the current or following Service Year program. Youthlinc makes every effort to contact participants about their refunds. Any allowable refund that is not collected by a participant after August 31 of any calendar year will be allocated to project funds or sponsorships. After August 31, our Year End, a participant can no longer collect an unclaimed refund.Assumption of Risk for the 2021 Youthlinc Service YearClick here to read the full assumption of risk. Assumption of Risk, Waiver of Liability, and Indemnification Agreement for Participation in Youthlinc Service Year, Covid Amendment Important: This is a legal document. Please read and understand this document before signing Signature page. TRAVEL DURING COVID-19 PANDEMIC Participant agrees that he/she/they will be vaccinated in order to travel, securing first vaccination six weeks before date of travel to ensure highest level of efficacy. Participant is responsible to secure their own vaccination appointment. Participant agrees to provide proof of vaccination immediately upon receiving the second shot (in the case they are receiving a two-shot regimen). White vaccine card, yellow WHO card, or signed letter from doctor is acceptable proof of vaccination. This will be uploaded securely through Youthlinc’s website. Participants will inform their Team Leader of vaccine status, including appointment set and/or first dose received so that Youthlinc can track and support this undertaking to help all participants achieve successful vaccination prior to travel. The University of Utah Health Clinic cannot guarantee enough product for the Travel Healthy Consultations scheduled in May. Participant agrees to appropriately wear a high-quality face mask during transit, including but not limited to airports, on all flights, and in all public spaces domestically and internationally in an effort to be cautious and respectful of others that may not have had the opportunity to be vaccinated or are unable to be vaccinated. Participants may remove masks at lodging, at meal times, and when social distancing outdoors or well-ventilated areas is possible. Whenever the team is working directly with community members abroad, including international partners and hospitality workers, they will remain masked when appropriate social distancing is not feasible. Participant agrees to get a PCR test 72 hours prior to departure to present to the airline and/or any customs officials in the US or abroad. Participant agrees to pay for this test and understands it is not part of Youthlinc’s program fee. Participant understands that upon receiving a positive PCR test that they will not be allowed to travel with Youthlinc and will forfeit all payments and donations toward the capstone trip—no refund will be given. Participant understands that upon departure from international location, he/she/they will be required to get another PCR test 72 hours prior to departure in order to gain entry back to the United States. Participant agrees to pay for this test on their own and understands it is not part of Youthlinc’s program fee. In the case that an adult participant tests positive for Covid-19 at any time during the trip, he/she/they understands that they are 100% responsible to undergo any government rules and/or regulations regarding their medical care, travel expense, or quarantine cost, even if it extends past the departure date of the team. No other team member, including the Team Leader, medical mentor, or other leader will remain with the participant if they are unable to travel home on the original schedule. Youthlinc is wholly released from responsibility. Participant is responsible for all costs associated to this situation. In the case that a minor participant tests positive for Covid-19 at any time during the trip, he/she/they understands that they are 100% responsible to undergo any government requirements and/or regulations regarding their medical care, travel expense, or quarantine cost, even if it extends past the departure date of the team. No other team member, including the Team Leader, medical mentor, or other leader will remain with the participant if they are unable to travel home on the original schedule. In this case, due to the participant’s status as a minor, a parent or guardian, or a person authorized by the parent or guardian, will be required to fly to the country where their child is to assume responsibility of their child. Youthlinc is wholly released from responsibility. Participant/participant’s family is responsible for all costs associated with this scenario. PARTICIPANT HAS CAREFULLY READ THESE TERMS AND FULLY UNDERSTANDS THEIR CONTENT AND IS AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN PARTICIPANT AND THE RELEASEES AND SIGNS IT OF HIS OR HER OWN FREE WILL. I have read and understand what is required of me in the Assumption of Risk waiver *I understandPreviousNextBy checking the box below, I am opting-in to receiving information regarding the Youthlinc Service Year (copy) *Opt InI have read and understand all of Youthlincs Policies and Procedures *I understandPolicies and ProceduresIn regards to the Summary of Understanding, Assumption of Risk, Waiver of Liability, Indemnification Agreement , Code of Conduct, and Polices for participation in the Youthlinc Service Year, I have carefully read these documents, fully understand and agree to the terms set forth in their content. I am aware that this is a release of liability and a contract between me and Youthlinc. I also acknowledge that this Agreement shall bind my heirs and personal representatives. *I agreePolicies and ProceduresI agree to abide by all the requirements and policies set forth in this Service Year registration. *I agreePolicies and ProceduresSignature of Participant *Participant email for application confirmation *I agree to abide by all the requirements and policies set forth in this Service Year application. *I agreePolicies and ProceduresSignature of ParentParent Email for application confirmation *DatePreviousMessageSubmit