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 24 -May 8, 2022.
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:
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 b{street32}ehavior 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 after submitting this "Online" Application: $180 application fee.
~ DUE Immediately after acceptance - $1,000 deposit
~ DUE DECEMBER 1, 2021: 50% of balance due.
~ DUE JANUARY 3, 2022: 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 3, 2022.
- 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.
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 8, 2022. 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.
2. Two (2”x2”) passport photos – These must be done professionally and are for security purposes.
3. March of the Living Medical Form – completed and signed by your physician Medical Form» Click and print form. Please note that only the March of the Living Medical Form will be accepted.
4. Immunization Record – this should be obtained from your physician.
5. Copy of COVID-19 vaccination card – This is a requirement as per the International March of the Living and the Ministry of Tourism in Israel.
6. Copy of the front and back of your medical insurance card
7. $180 Application fee – Please use this link 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.
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.