MARCH OF THE LIVING - SOUTHERN REGION April 24/25-May 8, 2022
Applicant Statement for Adult Participants
By enrolling in the March of the Living Program, I hereby agree to the following:
Acknowledgements• I will participate fully in all its aspects.• I agree to hold the leadership of the March of the Living, the cooperating agencies of the Southern Region, its representatives and staff, harmless of and from any and every claim arising from or by reason of any bodily injury, personal injuries known or unknown (including emotional trauma), death, or property damage resulting or alleged to result from any accident, incident, or other episode that may occur, whether based upon the negligence or breach of contract by, any Releasee or any other persons for whose acts or omissions any Releasee may be responsible in law or in fact, or any other use or principle of law as a result of my participation in the March of the Living or any activities in connection with the March of the Living or any other activity pertaining to this program, and agree to indemnify the sponsors of the March of the Living and its employees and cooperating agencies and staff for any costs which may arise in connection with this trip.
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 the 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 expense, or be treated in the countries I am visiting, at my expense, and there shall be no refund of monies paid to the 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. ~ I will travel with a written generic prescription for each medication I take. ~ I must also bring two complete sets of my medications with me.
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 within the framework of the medical services of the March of the Living leadership.
I agree to a payment plan as outlined, herein:
DUE immediately after submitting this online Application:
~ $180 Application Fee which FULLY refundable through October 31, 2021, with request, dated and in writing.
~ Pricing,deposit and fee schedule will be available by October 31, and will be shared with the participants in writing.
All withdrawal requests must be written and dated to take effect.
• I will secure independent trip interruption and withdrawal insurance, with a cancellation, medical coverage and evacuation policy. Proof of purchase will be provided to the March of the Living Southern Region Office. Failure to do this will abrogate this agreement.
• I will submit the photo page of an up-to-date passport and 2 passport size photos to the Southern Region office, immediately.
• I will submit a copy (Front and Back) of my personal health insurance card upon submission of this application.
•I will submit a copy of the COVID-19 Vaccination card.
I have read and will abide by the Policies detailed above.
I have made copies of this declaration and application for my records.