2025 March of the Living STUDENT TRIP Application Southern Region, USA

2025 March of the Living STUDENT TRIP Application Southern Region, USA

a proud program of the Jewish Federation of South Palm Beach County, Florida.
NOTE: ~ This Application form must be filled out by the student applying to the March of the Living Southern Region, specifically for the Student Trip planned for April 21 - May 2, 2025 (Dates subject to change). Students must be high school juniors or seniors in September 2024.

~ red star * indicates a required field and cannot be left blank.

THE SOUTHERN REGION IS COMPRISED OF: FLORIDA (EXCEPT BROWARD and MIAMI-DADE COUNTIES), GEORGIA, TEXAS, ALABAMA, TENNESSEE, MISSISSIPPI, KENTUCKY, LOUISIANA, ARKANSAS, SOUTH CAROLINA and NEW ZEALAND.
~ If you cannot finish the complete application in one sitting, simply close the
browser window. Everything (except dates) will be saved. If you open the
application on the same computer and with the same browser, you will be able to
continue filling out the application. You will have to re-enter any dates.
(Cookie issues)
Last Name - Exactly as it appears on your passport
Last*
First Name - Exactly as it appears on your passport
First*
Middle Name or Initial - Exactly as it appears on your passport. If your Middle Name is NOT on your passport, please leave blank.
Middle
Gender as appears on your passport*
First Name You Prefer to be Called
Pref First*
Date You Were Born (EX: 01 01 2002)
D.O.B.*

MonthDayYear
Home Street Address
Street*
City*
State*
Zip*
Your Home Community
COM*
Candidate Status (check one)
Status*

StudentSurvivorStaffClergyMedical Personnel
Candidate Phones (Example: XXX-XXX-XXXX)
Cell*
Home
Personal Email *
School Email*
example@example.com
PARENT or GUARDIAN INFORMATION
Parent 1 - Information
Parent 1 - First Name*
Parent 1 Last Name*
Parent 1 is*

LivingDeceasedOther
Parent 1 Email*
Parent 1 Cell #*
Parent 1 Home #
Parent 1 Work #
Parent 1 Street Address*
Parent 1 City*
Parent 1 State*
Parent 1 Zip Code*
Parent 1 Occupation*
Parent 1 Employer*
Parent 2 - Information
Parent 2 First Name*
Parent 2 Last Name*
Parent 2 is*

LivingDeceasedOther
Parent 2 email*
Parent 2 Cell #*
Parent 2 Home #
Parent 2 Work #
Parent 2 Street Address*
Parent 2 City*
Parent 2 State*
Parent 2 Zip Code*
Parent 2 Occupation*
Parent 2 Employer*
Parents' marital status
Parents*

MarriedDivorcedSeparatedWidowed
If parents are divorced, or one is deceased etc., are either remarried?
Remarried

Parent 1 RemarriedParent 2 RemarriedBoth Remarried
Which parent(s) do you live with?
Live with*

BothParent 1Parent 2GuardianOther
Sibling Information
If you have siblings, please list their names and their current school grade.
Sibling #1
Sibling #2
Sibling #3
Emergency Contact Information
EMERGENCY CONTACT INFORMATION (FOR STUDENTS: MUST BE SOMEONE OTHER THAN PARENT OR GUARDIAN)
E-Name*
FIRST and LAST NAME
E-Relation*
E-Cell*
E-Home
E-Email*
Passport and Citizenship Information
STUDENTS MUST COMPLETE THIS SECTION WITH A PARENT.
Important: A copy of the inside "picture page" of your passport and TWO legal 2" x 2" passport photos must be submitted to the Southern Region office. (The photos are a MUST for security purposes.)
Please upload a copy of the inside "picture page" of your passport *

Browse Files

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If your passport will expire before November 10, 2025 or you do not have a valid passport, you must apply for a passport immediately. Your a application cannot be processed until proof of passport or passport application is shared with the Southern Region. This must be done within 10 days of application submission.
FOR STUDENTS WITH ISRAELI CITIZENSHIP, OR HAVE ONE OR MORE PARENTS THAT HAVE OR HAD ISRAELI CITIZENSHIP, YOU WILL NEED AN EXEMPTION (PATOR, פטור ) FROM ISRAELI MILITARY SERVICE TO DEPART ISRAEL. IF THIS APPLIES TO YOU, YOU MUST CONTACT THE ISRAELI CONSULATE AND REQUEST A PATOR, פטור IMMIDIATELY AND SUBMIT A COPY TO THE SOUTHERN REGION OFFICE. ISRAELI CONSULATE MIAMI - 305.925.9400.
Are you an Israeli Citizen?
Israeli*

YESNO
Did either parent hold Israeli citizenship?
Israeli Parent*

YESNO
Full Exact Name as It Appears on Your USA Passport (Re-enter for validation purposes)
Passport Name (Exact Name as it appears on your passport)*
Passport Number*
Passport Expiration Date (Must be Valid through November 10, 2025 or after)
PP Expiration Date*

MonthDayYear
Israeli Passport Number (If none, type "no")
Passport # Israel*
Israeli Passport Expiration Date
Passport Israel Expiration Date

MonthDayYear
Which country are you a Citizen of?
Citizen*
What Size March of the Living T-Shirt Would You Like to Have? (All Shirts in Men's sizes and run true to size)
Shirt*
What Size March of the Living Jacket Would You Like to Have? (These run LARGE)
Jacket*
PRIOR ISRAEL and Other TRAVEL EXPERIENCE
Have you ever visited Israel?*

YESNO
If yes, how many times have you visited Israel?
Personal Profile information
HOW WOULD YOU BEST DESCRIBE YOURSELF? PLEASE BE SURE TO INCLUDE YOUR STRENGTHS AND WEAKNESSES.
I see myself...*
DESCRIBE WHERE YOU SEE YOUR LIFE IN TEN YEARS (Career, Family, Responsibilities)
In 10 years I ...*
LIST YOUR SPECIAL INTERESTS AND HOBBIES:(Example; Reading, Writing, Photography, Videography, Poetry, Sports, Civics, Volunteering Etc.)
Interests*
Music plays an important role on the March of the Living. We are always looking to identify participants who love to sing, and enjoy sharing their voice with others.
Do you sing?
Sing

YesNoOther
Do you play a musical Instrument?
Music

YesNo
Which Musical Instrument Do You Play?
Instrument
Would you bring the musical Instrument on the Trip? (We have ceremonies and other activities where music is important and adds to everyone's experience)
Instrument on the Trip

YesNo
Have You Ever Been Arrested?
Arrested?*

YesNo
Explain*
Have You ever been suspended from school?
Suspended?*

YesNoOther
Explain*
Have You ever been asked to leave a program? (This includes summer camp, youth group, or any group activity)
Leave Program?*

YesNoOther
Explain*
Have You Had a Significant Personal Loss in the Last 2 Years?
Loss*

YesNo
Describe Loss*
HOLOCAUST CONNECTION
List relatives who have been on the March of the Living and are "March" alumni
Alumni
List Relatives Who Were Holocaust Victims and/or Survivors
Survivor
JEWISH IDENTIFICATION
With which denomination of Judaism do you most identify?
Jewish ID*
Which Prayer Book (Siddur) do you prefer to use?
Siddur*
Are You a Member of a Synagogue?
Member*

YesNo
If yes, please share the name of the synagogue you belong to.
Synagogue:
Your Rabbi's Name
Rabbi*
How do you keep Kosher?
Kosher*
Medical Information

Students must complete this section with a parent.
Health Insurance Company and Policy Number. Please note that Health Insurance Coverage is required for participation on the March of the Living.
Insurance Co.*
Ins Policy #*
Name of Person in Household Who is Considered the "Primary" Insured
Primary Ins*
Please upload Front of Student's Medical Insurance Card*

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Please upload Back of Student's Medical Insurance Card*

Browse Files

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Do You Suffer From Allergies?
Suffer Allergy?*

YesNo
What kind of allergies do you suffer from? Please specify all allergies, including allergies to medications. Also please list the treatment used for those allergies.
Allergies*
What are your physical reactions and symptoms when exposed to to the allergens?
Reaction*
Have you been hospitalized in the past 2 years?
Hospital*

YesNo
Describe why and when you were hospitalized.
Hospital Information (Physical and/or Psychological)*
Please NOTE HERE if you require a special diet: (Choose as many as apply)
Spec Diet

Gluten Free DietVegetarianVeganPescatarianNut FreeDairy FreeOther
If you marked other, please describe.
From the list of medical conditions below, please check off all that apply to you:
Medical Conditions

AnemiaArthritisAsthmaBleeding DisorderChronic BronchitisChemical DependencyContact LensesDiabetesEating DisordersEpilepsyEye DisordersEye GlassesFainting SpellsFrequent ColdsGerman MeaslesG.I./Stomach ProblemsHay FeverKidney AilmentsMigrainesMenstrual ProblemsMononucleosisMotion Sickness/VertigoOrthopedic FracturesPneumoniaRheumatic FeverScarlet FeverSinusitisSleep ApneaSleep WalkingThyroid ConditionTuberculosisTumorsADDADHDCeliacMental Health DisorderCardiac ConditionOther
If you marked other, please describe.
If you checked any of the above please give all details including name(s), date(s) and address(es) of physicians and hospitals.
Med Details
If you are taking medication(s) now, list the medication name(s) below, along with:
a) dosage in MG
b) prescribing Physician(s)
c) condition the medication is treating.

If not taking meds, type "N/A".
Meds Now*
Personal Medical Assessment: In Consultation with my Parent(s), we certify that I am able to participate on the March of the Living, knowing, full well, that the trip is strenuous and that I will undergo different sleep patterns based on Time-Zone changes, frequent bus travel, late curfews, early wake-ups and numerous consecutive hours on my feet and walking. WE FURTHER CERTIFY THAT WE WILL DOWNLOAD FROM THE WWW.MOLSOUTH.ORG WEBSITE THE MOL SOUTH MEDICAL FORM WHICH MUST BE FILLED OUT BY OUR PHYSICIAN & WILL SEND THE FORM TO THE SOUTHERN REGION OFFICE WITHIN 10 DAYS OF COMPLETING THIS APPLICATION.
I agree to the terms for the Personal Medical Assessment*

Yes
Educational Data

For Student applicants only
In September 2024, I will be a.....
Grade*

JuniorSenior
HS Name*

American HeritageBoca Prep HSBenjamin HSBoca Raton HSDKJA Rosenblatt HSDreyfoos HSDwyer HSGrandview Prep HSG-Star HSJupiter HSKatz YHSNorth Broward Prep HSOlympic Heights HSOxbridge Prep HSPalm Beach Central HSPalm Beach Gardens HSPinecrest Prep HSSpanish River HSSt Andrews Prep HSStoneman Douglas HSSuncoast HSWest Boca HSWeber HS ATLAtlanta Jewish AcademyAtlanta - North Springs HSOther
Please List Your High School Principal and Guidance Counselor Below
Principal*
Counselor*
Let Us Know About Your Jewish Education Experience
Jewish Ed

Hebrew SchoolYeshivaJewish Day SchoolSunday SchoolPrivate TutoringJewish Summer CampNoneOther
Describe Any Youth Group, Club or Social Action Participation You Are Part Of, or Have Been Associated With. Include Leadership Positions and Accomplishments.
Youth Group
Please list the first and last names of your friends applying for the March of the Living. If none of your friends are applying, write "N/A".
Friends applying*
In less than 150 words, describe why you are a candidate our panel will choose to participate on the March of Living. Why is participation on this trip so important to you that you are willing to miss two weeks of school and take responsibility for making up your school work?
Essay*
"Code of Conduct"

This must be read by Student, Parent or Adult prior to submitting Application.

MARCH OF THE LIVING - SOUTHERN REGION - APRIL 21, 2025 TO MAY 2, 2025 (Dates subject to change).

All student participants will subscribe to the following set of behaviors during March of the Living experience with the Southern Region:

1. Personal Integrity: You represent not only the American delegation, but also the entire International March of the Living. Your actions should never put you or any other members of the group in a compromising situation.

2. Hotel: No one may leave the hotel premises or grounds without specific permission of the Bus Captain or Travel Group Leader. No student is allowed in any of the hotel restaurants. Delivery of food from such entities as Uber Eats is strictly forbidden.

3. Hotel Property: No towels, pillows, etc. may be taken from the hotel. Any damage to a hotel room will be charged to all individuals assigned to that room.

4. Keys: Room keys are shared with roommates. Should you or anyone in your room lose the key, an up-to $75.00 lost key fine must be paid by everyone assigned to the room.

5. Courtesy and Respect: Other hotel guests exist. Show them the same respect that you would like them to show you. Staff and adult participants are due the same type of courtesy and respect. SEE RULE NUMBER ONE.

6. Rooming: All students will sleep in their assigned rooms, with no changes, unless instructed to do so by Travel Group Leader.

7. Lock Hotel Room Doors: All rooms must be locked upon leaving the room, even if you are just going down the hallway. When inside the room lock your door!

8. Room Visitation: Students may not be inside opposite gender rooms. All such meetings may take place in assigned areas.

9. Curfew & Wake-Up: Each participant is responsible for his/her roommates in terms of curfew and wake-up. Curfew is enforced. Gross violation can send participant home at his/her and family expense.

10. Visitors: Permission to have visitors must be obtained from the Travel Group Leader. No outside visitor is allowed in your room or on the sleeping floors at any time. Visitors may see you only during announced visitation time. All visitors must leave the hotel at assigned times. You are responsible for the actions of your visitors.

11. Room Charges: No room charges are to be made including long distance phone calls, rent-a-movie, room service, etc.

12. Alcohol, Drugs, Smoking, Vapes, E-Cigarettes and Illegal or Unauthorized use of Prescription Medicine are strictly forbidden: Student participants are not allowed in drinking establishments, even if they drink only non-alcoholic beverages. Due to the seriousness of this rule, all students agree to inform the staff of any violation, or pending violation, of other students. Violation will result in sending those students home at parent’s expense, no matter who is responsible.

13. Participation and Attendance: Prompt attendance at all sessions is required.
a. Meals: Attendance at all meals is required. Let your Bus Captain know if you need to leave the dining room.
b. Prayer: Attendance at Morning Prayer services is a requirement of all students. Students select which service they wish to attend. Attendance is taken daily. Afternoon & evening services are optional.

14. Luggage: All luggage is the responsibility of the individual student. Any luggage damaged or lost during the March of the Living is not the responsibility of the Southern Region or the International March of the Living.

15. I.D. Badges: March of the Living ID badges must be visibly worn at all times.

16. Masks: Facial Masks may be required and will be enforced according to local mandates.

17. COVID-19 Testing: All participants may be required to take PCR and Rapid tests as a requirement for participation on the March of the Living and as mandated by Poland, Israel and the United States.

18. Cell Phones: These may not be used for personal calls or texts during Program times. Staff will determine inappropriate use of cell phones. In such a case, the phone may be confiscated.

19. Pre-Trip Classes and Meetings: You are required to attend all preparatory and post – MOL sessions, classes and retreats.

Failure to abide by the rules as set above, could lead to your not being able to participate in the March, or being sent home from Poland or Israel. Any cost incurred in sending a participant home due to the violation of the Code of Conduct will be at the participant’s and his or her parent’s or guardian’s own expense.
We, hereby, understand and agree to the terms stated on the application for the March of the Living and will abide by these terms. When the completed form is returned to us via electronic mail, we will keep a copy of this application for our records. We have answered all questions, honestly, and to the best of our ability. We understand that we will be reuired to sign a liability waiver which will be requirement for participation on the March of the Living.
Student Signature*

Yes
Signature*

Clear
Parent Signature*

Yes
Signature*

Clear
Applicant Statement and Personal Medical Disclosure Statement

This must be read by STUDENT and PARENT prior to submitting the Application.*MARCH OF THE LIVING - SOUTHERN REGION April 21 -May 2, 2025.

Applicant Statement for Student Participant

By enrolling in the March of the Living Program, an intensive Jewish educational experience, I hereby agree to the following:

Acknowledgements:

1. I will participate fully in all its aspects (including daily prayer services in the mornings).

2. I will abide by all its rules and regulations as detailed on the Code of Conduct, above.

3. I will attend all classes, student retreats and other programs prior to and immediately after the March of the Living.

4. I acknowledge the fact that usage or involvement in alcoholic beverages, drugs or narcotics or any other type of anti-social behavior is cause for my immediate dismissal from the program. This applies to my behavior prior to the trip and after being accepted as a participant on the March of the Living. If I am involved in such illicit behavior on the trip, I understand that my return to the USA will be at my own or my family's expense.

5. I and one of my parents will have read and filled out this application form.

Medical:

I hereby certify that the Medical Information section is complete and full disclosure on any and all Physical and Mental health issues have been included. It is the intention of the March of the Living to rely on this completed form and supplementary letters in determining my acceptance and continuation in this program. Omissions or misstatements are at my risk and that of my physician(s) or therapist(s).
~ Should I be found to have any mental or physical condition that is not fully disclosed in this Medical Form or in an accompanying letter from an appropriate, qualified medical or psychological professional, then ….

A. …. I may, at the sole and absolute discretion of the program, be dismissed from the program prior to departure or returned to the USA at my or my parent's expense, or be treated in the countries I am visiting, at my or my parent's expense, and there shall be no refund of monies paid to this program.

B. …. The Jewish Federation of South Palm Beach County, The March of the Living, Southern Region and the International March of the Living and all additional sponsoring organizations are hereby released from all responsibility or liability of any kind whatsoever arising out of any aspect of my medical history and mental or physical condition.

~ All medication that I take regularly is detailed in this Application Form in the Medical Information Section.
~ If I will be taking prescription medication while on the trip, I will submit a written report giving full details of each medication.
~ I will travel with a written generic prescription for each medication.
~ I must also bring two complete sets of my medications with me.

Payments:

Base Fee: TBD*

* For students who live outside the Jewish Federation of South Palm Beach County sevice area, the price must be discussed with your City Coordinator or Representative. You may also contact the March of the Living office in Boca Raton. 561-852-6041 or MOL@bocafed.org.

~ DUE Immediately $750 deposit due with application (Payment link will be emailed after application has been submitted). Deposit is refundable until final program pricing is disclosed.

Obligations:
We agree to submit the following 7 items to the March of the Living Southern Region office within 10 days of receipt of this application.

1. Copy of the picture page of your passport – Passport must not expire prior to November 10, 2025. If you do not have a current passport, please apply for a new one immediately. Once you apply for a new passport, send a copy of the receipt to the Southern Region office. Due to high demand, passports are currently taking 16-18 weeks. (uploaded with your application)

2. Two (2”x2”) passport photos – These must be done professionally and are for security purposes. Local students, must bring to their March of the Living Interview. All others, please mail to: March of the Living, 9901 Donna Klein Blvd, Boca Raton, FL 33428.

3. March of the Living Medical Form – completed and signed by your physician Click and print Medical Form here. Please note that only the March of the Living Medical Form will be accepted.

4. Immunization Record – this should be obtained from your physician and submitted with the March of the Living Medical Form.

5. Copy of the front and back of your medical insurance card (uploaded with your application).

6. $750 Deposit – Please click here to make your payment MOL Payment – Please contact the Southern Region office, if you have a financial challenge.

Please note, you have 10 days to submit all of your documentation from receipt of this email. Interviews will be scheduled upon receipt of all of your documents. If we do not receive your documents within the required 10-day period, you may be placed on a waitlist.

Contact information and mailing address:

March of the Living Southern Region.

9901 Donna Klein Blvd.

Boca Raton, FL 33428

561.852.6041

mol@bocafed.org

~I have read my child's statement above. I agree to all its content and conditions.
Parent Signature*

Yes
Signature*

Clear
Student Signature*

Yes
Signature*

Clear
IMPORTANT FURTHER REQUIREMENTS, DEPOSIT AND PAYMENTS:
APPLICATION SUBMISSION: WHEN YOU SUBMIT THIS APPLICATION, CHECK THE INBOX OF THE EMAIL ADDRESS YOU SUBMITTED. YOU SHOULD RECEIVE A "CONFIRMATION EMAIL". THIS WILL BE YOUR GUIDE FOR THE NEXT IMPORTANT STEPS IN THE APPLICATION PROCESS. STUDENTS: Forward the Payment Page to your parents. Inform them of your application to assure prompt payment. Application Fee MUST BE SUBMITTED FOR YOUR APPLICATION TO BE CONSIDERED. You can only be interviewed if all required items are submitted. BY SUBMITTING THIS APPLICATION YOU ARE REQUESTING TO BE CONSIDERED FOR CANDIDACY AS A PARTICIPANT ON THE MARCH OF THE LIVING WITH THE SOUTHERN REGION OF THE USA.
DEPOSIT: AFTER YOU CLICK THE SUBMIT BUTTON, YOU WILL RECEIVE AN IMMEDIATE NOTICE FOR A CREDIT CARD PAYMENT. A $750 DEPOSIT IS REQUIRED TO HOLD YOUR SPACE AND TO ALLOW US TO PROCEED TO SCHEDULE AN INTERVIEW WITH A PANEL OF LOCAL MARCH ALUMNI. NOTE: Louisville, Sarasota and New Zealand do not send deposits. Work through your city and country representatives. Ignore the Payment Window that pops-up.

PARENTS: In cases of financial need, see www.molsouth.org to contact your local city representative who will guide you at this point.
FINANCIAL ASSISTANCE: GENEROUS SCHOLARSHIPS AND FINANCIAL AID ARE AVAILABLE. INQUIRE OF YOUR CITY REPRESENTATIVE, SCHOOL, JEWISH FEDERATION AND SYNAGOGUE. IF YOU NEED FINANCIAL AID CLICK WWW.MOLSOUTH.ORG FOR CONTACTS IN YOUR AREA. PLEASE BE SURE TO FILL OUT ALL FORMS COMPLETELY.
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2025 March of the Living STUDENT TRIP Application Southern Region, USA

Parent 1 - Information

Parent 2 - Information

Sibling Information

Emergency Contact Information

Passport and Citizenship Information

Personal Profile information

Medical Information

Educational Data