Please enable JavaScript in your browser to complete this form.Participant InformationName *FirstLastEmail *Phone *Current Team *CambodiaFiji JuneFiji JulyGuatemalaJamaicaKenyaMongoliaNepal 1Nepal 2Peru JunePeru JulyThailand JuneThailand JulyVietnamAre you a returning participant (joined in the 2019/2020 Service Year) or a new participant (joined in the 2020/2021 Service Year) *ReturningNewCurrent Age *Parent Name *FirstLastParent Email *Parent Phone *Youthlinc Service Year International TripI would like to travel in: *Summer 2021Summer 2022Neither of these options work for me.Neither of these options work for me.Would you be open to a Winter 2021 Trip if we made it available? *YesNoMaybeWould you like to participate in a local alternative? *Yes, I would like to participate in a local experience.No, I would like to drop and receive a refund.RefundI have read and understand all the information in Youthlinc Service Year Refund Policy *YesWhat would you like to do with your refunded amount? *Future project fundsFinancial aid for a future participantA donation to another Youthlinc program like Real Life, Local Service Directory, Young Humanitarian Award, or Capital CampaignReturn the refund amount to meNo donation was madeAmount elidgible for refund *Please explain the specificsWho would you like the check made out to? *Where would you like the check sent? *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLate Summer 2021Late Summer 2021 Team Option 1 *Jamaica JuneJamaica AugustCosta Rica JulyCosta Rica AugustPeru JulyPeru AugustKenyaNepalLate Summer 2021 Team Option 2 *Jamaica JuneJamaica AugustCosta Rica JulyCosta Rica AugustPeru JulyPeru AugustKenyaNepalAssumption 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 understandParticipant Signature *Participant Date *Parent Signature *Parent Date *Summer of 2022Thank you for designating you would like to postpone to Summer of 2022. We will reach out to you in July about priority placement on to the team of your choosing.Local ExperienceWould you like to participate in a Local Alternative Option? *YesNoPlease indicate which local experience you would be interested in: *Four Corners Navajo Cultural Exchange tripConservation Camping TripRefugee Services in SLCSubmit