• 2025 March of the Living Southern     Region Adult Bus Application     

    2025 March of the Living Southern     Region Adult Bus Application     

    a proud program of the Jewish Federation of South Palm Beach County, Florida
  •  
    Note:
    ~ This Application Form should be filled out by the Adult applying to the March of the Living Southern Region, specifically for the Adult Bus Group planned for April 22 - April 28, 2025. 
    ~ 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 need to re-enter dates.      
    NOTE: Couples who apply should use a different computer for each application to avoid cookies.
    ~ March of the Living alumnus, Rabbi Leon Weissberg, EdD. will, once again, be leading and educating adults from our region on this unforgettable journey.
    ~ Lines with a red star* indicate required fields. 
    ~ This Adult Bus Group will have opportunities to travel along-side student buses from the Southern Region in Poland, and will experience a thought-provoking schedule in Israel, with ocassional opportunities to interact with the students. Questions may be emailed to MOL@Bocafed.org or call 561-852-6041.
     

  • Personal Data

  • Last Name, (EXACTLY AS IT APPEARS ON YOUR PASSPORT)
  • First Name, (EXACTLY AS IT APPEARS ON YOUR PASSPORT)
  • Middle Name or Initial (IF IT APPEARS ON YOUR PASSPORT)
     
  • First Name you prefer to be called
     
  • Date of Birth (EX:   01   -    01    -   1951)
     
  •  - -
  • Home Address
     
  • Your Home Community
  • Candidate Status
  • Email Address
  • Applicant's Phone number: (Example: XXX-XXX-XXXX)
     

  • Passport and Citizenship Information

  • 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.)
     
  • Important: If your passport will expire before November 10, 2025, you must apply for a passport now. Please do not wait, as it can take months to receive your new passport, and we are unable to purchase airline tickets without a CURRENT passport.
     
  • Exact Name as it appears on your passport, including middle name if it appears on your passport only. (PLEASE RE-ENTER FOR VALIDATION PURPOSES)
     
  • Browse Files
    Cancelof
  • Passport Expiration Date (Must be Valid, at least until November 10, 2025)
     
  • Important: Homeland Security dictates that all passports must be valid 6 months after returns from an international trip. Now is the time to renew your passport, if it expires between now and November 10, 2025.
     
  •  / /
  • Which country are you a citizen of?

  • Personal Profile Information

  • What size March of the Living t-shirt would you like to have? (Men's sizing)
     
  • What size March of the Living jacket would you like to have? (Jackets are Men's size and run large)
     
  • Have ever been to Eastern Europe/Poland or Israel?
  • Do you have a child or grandchild traveling on the 2025 student bus with MOLSouth?
     
  • Have you ever been arrested?
  • Have you had a significant loss in the last 2 years?
  • HOLOCAUST CONNECTION
  • List relatives who have been on the March of the Living and are "March" alumni
  • List relatives who were Holocaust victims and/or Survivors
  • JEWISH IDENTIFICATION
  • Please share with which denomination of Judaism you most identify.
     
  • Are you a member of a synagogue?
  • Which synagogue do you belong to?
  • Your Rabbi's name

  • Personal Profile Information

  • Please share your custom for keeping kosher?

  • Are you Shomer Shabbos (Strict Shabbat Observance)?

  • Over Shabbat do you prefer a room on a lower floor?

  • Please note here if you require a special diet. (Choose as many as apply)


  • EMERGENCY CONTACT INFORMATION
     
  • Emergency Contact #1
     
  • Emergency Contact #1 - Cell Number
     
  • Emergency Contact #1 - Second Phone Number
     
  • Emergency Contact #2
     
  • Emergency Contact #2 - Cell Number
     
  • Emergency Contact #2 - Second Phone Number
     
  • MEDICAL INFORMATION
  • Health Insurance Company and Policy Number (If none, type "no")
  • Name of person in household who is considered the "Primary" insured
  • Do you suffer from allergies?
  • What kind of allergies do you suffer from? Must include medication and drug allergies. (If none, type "no")
  • What are your physical reactions and symptoms when exposed to the allergens? (if none, type "no")
  • How do you treat the reaction from your allergies? (if none, type "no")
  • Do you carry an EpiPen?
     
  • Have you been hospitalized since 2020?
     
  • Describe why and when you were hospitalized.
  • Check any and all that apply to you:
     
  • If you checked any of the above please give all details including name(s), date(s) and address(es) of physicians and hospitals.
  • If you are taking medications now, list them below with a) Dosage in MG, b) Prescribing Physician, c) Condition the Medication is Treating. If not taking Meds, type "no". Example: Zyrtec 20 mg 1X/day / Dr. Cohen / Allergic Rhinitis
  • Personal Medical Assessment: "I 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."     Please check YES if you are in agreement with this statement.
     
  • Clear
  • "Participant Statement of Understanding" This must be read prior to submitting the Application.*
  • Participant Personal Medical Disclosure Statement and Statement of Financial Obligations 
  • All participants subscribe to the following set of guidelines for the entire March of the Living experience with the Southern Region:
    1. Classes, Meetings and Education: You are encouraged to attend pre and post – MOL sessions, classes and retreats. Specific classes for adult participants will be scheduled in January through April 2025. Tentatively, there will be  three 2-hour sessions along with suggested reading material before the trip. An Orientation will be scheduled a few weeks prior to the trip.
    2. Rooming: Double Occupancy. You may upgrade to a single room for an extra fee per country. If we can not match you with a roommate, you are obligated to purchase a single room at the additional prices provided by the International March of the Living.  
    3. Luggage: All luggage is the responsibility of the individual. Any luggage damaged or lost during the March of the Living is not the responsibility of the Southern Region or the March of the Living International and affiliated organizations.
    4. I.D. Badges: March of the Living ID badges must be visibly worn at all times.
    5. Remaining with the Group: You are required to stay with the group at all times, unless pre-arranged side-trips with the agreement of the Bus Captain and Security have been made. Side-trips are at the expense of the adult participant and in agreement with the Regional Director or designee.
    6. Travel Inurance - including interruption, cancellation, and medical coverage is required-  Before participants can be accepted into the program, proof of purchase is required (No Exceptions).
    7. Non-Compliance "by choice" Clause: If at any time you do not feel you can follow any of the guidelines as established by the March of the Living, you may ask permission to leave the group at your expense and go back to the U.S.A. No Refunds will be issued. 
    8. Non-Compliance "by personal injury" Clause: In the event of an injury that prevents you from keeping up with the group, you will be obligated to contact your travel insurance provider and make arrangements to leave the trip. No Refunds will be issued.
    9. Flights: Participants are responsible for booking their own flight to Krakow, arriving on April 22, 2025. The trip will begin at 3pm. Participants must book their return flight from Warsaw, departing on April 28, 2025 after 7pm. 
    10. Plans subject to change: The March of the Living has planned a meaningful experience for all participants but plans are subject to change.   
    11.Participant Agreement: Participants will be required to sign a liability waiver from the International March of the Living and the Jewish Federation of South Palm Beach County. Waivers will be forthcoming when travel plans are finalized.
    This experience will be like no other experience in your life. It will be meaningful and exciting, but also tiring. You must be able to walk on your own without assistance for long periods of time. 
     
    YOU ARE AGREEING TO ABIDE BY ALL THE RULES AS SET FORTH HEREIN, OR ANY ADDITIONAL RULES AS ESTABLISHED BY THE INTERNATIONAL MARCH OF THE LIVING OR THE SOUTHERN REGION of the MARCH OF THE LIVING.
  • Clear
  • I, 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 me via electronic mail, I will keep a copy of this application for my records. I have answered all questions, honestly, and to the best of my ability.
    By typing my name below, I agree that this will serve as my signature and is binding according to the answers provided in this application.
     
  • IMPORTANT FURTHER REQUIREMENTS, DEPOSIT AND PAYMENTS:
  • Deposit: After you submit this application, a new window with an online link for secure credit card payment will appear. A $1,000 REFUNDABLE DEPOSIT IS REQUIRED UNTIL November 15, 2024 to hold your space and to allow us to review your application. We accept American Express, Discover, Visa, and Master Card.
     
  • Application Submission : After you submit this application, please check your email for confirmation of your application. This will also include your guide for the next important steps in the application process. please be sure to save the email. By submitting this application, you are requesting to be considered as a participant on the March of the Living with the Southern Region of the USA.
     
  • Should be Empty: