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 April 19-May 3, 2020.
Applicant Statement for Student and Adult Participants
By enrolling in the March of the Living Program, an intensive
Jewish educational experience, I hereby agree to the following:
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 ilicit 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.
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 leadership of this program and its 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.
~ To be interviewed as participant on the March of the Living, I will submit a signed copy of the March of the Living physical examination form, found on the www.MOLsouth.org website filled out by my personal physician along with a copy of my Immunizations record from my school. Two 2"x2" passport photos, including a copy of the current inside picture page of my passport and a copy of my family medical insurance card will also be submitted. Deposit, as noted, is also required. I will act quickly on these requirements.
* (subject to possible 5% increase by the International March of the Living): (Domestic flights to and/or from JFK airport, if necessary, are NOT included)
* 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. 561-852-6013 or
~ DUE Immediately
after submitting this "On-Line" Application: $1,000 deposit, of which $250 is a non-refundable registration fee due with complete "on-line" application.
~ DUE DECEMBER 1, 2019
: 50% of balance due.
~ DUE JANUARY 15, 2020
: Remainder of balance due.
I am aware that a late payment fee of 5% of my balance will be assessed if I do not pay my bill, in full, by January 15, 2020.
I am aware that if I request financial assistance, I must contact my local city representative and establish a payment plan, mutually agreeable to them and myself.
All withdrawal and transfer requests must be written and dated to take effect. In the event the applicant transfers to another region, the Southern Region will keep all monies paid out on the applicants behalf, based on the due dates of the refund policy found herein.
We will submit the following 6 items to the March of the Living Southern Region office (or to my City Coordinator for specific non-Boca Raton and West Plam Beach participants), before the interview can be scheduled ...
1. Deposit of $1,000. Except Louisville, Sarasota and New Zealand.
2. MOLSouth Medical Form. (Other forms are not accepted)
3. Copy of Immunization Record (STUDENTS ONLY).
4. Copy of Family Health Insurance Card (front and back)
5. Two - 2 X 2-inch Passport Sze Photos. Only actual legal photos accepted.
6. Copy of "inside picture page" of your passport. IMPORTANT: Due to Homeland Security Rulings, the passport must expire after November 3, 2020 (Valid copy of passport application receipt accepted; we will interview).
INTERVIEW: Every student applicant must submit all of these items in order to be scheduled for an interview to procure the opportunity to participate on the March of the Living.
~I have read my child's statement above. I agree to all its content and conditions.
ADULT APPLICANTS ONLY:
I agree with all aspects of the Permission Form below as it pertains to my candidacy on the March of the Living. I give my full permission for all treatment of any nature deemed necessary by doctors in Europe, Israel, and the USA to be extended to me (adult applicant) or my child (student applicant) within the framework of the medical services of the March of the Living leadership.