Summer 2021 Local Alternative Experience Registration If you are a Youthlincer who completed their Local Alternative trip preference on the Postponement Decision form, you DO NOT need to complete the registration again. Please enable JavaScript in your browser to complete this form.Local Trip Preference - Step 1 of 5What local alternative are you signing up for? *Refugee Summer FestivalFour Corners: Past and PresentConservation Camping TripAre 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.NextName *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 *MaleFemalePrefer not to specifyBirthdate *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Current Age *T-shirt size: *XSSMLXLXXLMen's sizesPreviousNextName of emergency contact: *FirstLastEmergency contact's relationhsip to you: *Emergency contact's e-mail address: *EmailConfirm EmailEmergency contact's phone number: *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 SeniorEnter second language(s) and your level of proficiency if applicable:PreviousNextBy checking the box below, I am opting-in to receiving information regarding the Youthlinc Service Year *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 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 *DatePreviousNameSubmit