Activate Youth and Multigenerational Journeys - Registration

Activate Youth and Multigenerational Journeys - Registration

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UU College of Social Justice

This form is for both youth and adults registering for Activate Justice Journeys. If you are a youth under the age of 18, you must complete this form with the support of a parent or guardian. If you have any questions about the form, please contact info@uucsj.org.

Select the journey you are applying for:

How did you hear about this UUCSJ journey?

Applicant Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

Postal Code

Country

State/Province

Provinces

Email

Phone

Birthdate

Please use a format such as 05/27/1975

Current class year

If you are currently between grades, select the grade you were in during the previous school year.

Parent/Guardian and Emergency Contact Information

Are you under 18 years old?

YesNo

Parent/Guardian name

Parent Primary Phone Number

###-###-####

Parent Primary e-mail address

All participants: Please enter an Emergency Contact and their contact information

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

###-###-####

Emergency Contact e-mail address

Short Answers - Please answer the following questions in detail, with at least 3-5 sentences each.

Please describe any involvement you've had with social justice activities, community service projects, and/or youth leadership experiences in your congregation, school, or community.

What interests you about this specific Activate Journey? What do you hope to gain from this experience?

What do you anticipate finding challenging about this experience? What helps you cope with challenging experiences? Are there any supports you need to help you participate fully?

Do you have any accessibility needs that we should be aware of? This could include an accessible room, alternative materials, requests/questions about mobility, accommodations, etc.

Is there anything else you would like us to know?

Are you traveling with your youth group?

yesno

Reference Information

As part of the application process, we may contact a personal reference. If you attend a UU or other religious congregation, we request that this reference be your minister, a religious educator, or other congregational leader. If you do not attend a congregation, this reference should be an adult who is not a relative, and who can speak to your personality and leadership development. Teachers, coaches, and supervisors are all good options.

Please ask an adult to serve as a reference for you and share their information below.

Reference 1 - Name

Reference 1 - Position/Relation

Reference 1 - Phone Number

###-###-####

Reference 1 - e-mail address

Reference 2 - Name

Reference 2 - Position/Relation

Reference 2 - Phone Number

###-###-####

Reference 2 - e-mail address

Trip Requirements

Please read the following carefully and check that you understand and agree below.

1.) I acknowledge that as a participant in this program, I am committed to carefully reviewing and following all UUCSJ rules and regulations and that I will actively uphold a covenant created with others in the group once the program begins.

2.) I acknowledge my understanding that this Activate Journey is a rigorous experiential learning program that requires my full participation in group activities, community building, and reflection.

3.) I acknowledge that I have had a tetanus shot within 9 years of the program start date, or will have one before the program begins.

4.) I acknowledge that I have health insurance that covers me in the program destination for the duration of the program, and I am willing to share my insurance details with UUCSJ in advance of the program.

5.) I acknowledge that UUCSJ strongly recommends that in advance of my program I review the Center for Disease Control's immunization recommendations for the program destination.

6.) I acknowledge that I am fully vaccinated against COVID-19, or I will be before the program begins. I will follow the COVID-19 protocols of UUCSJ and our partners.

7.) I acknowledge that, if traveling internationally, I am required to have a current passport and possibly a visa prior to the program start date, and that obtaining those documents is my responsibility.

I have carefully read the statements above and agree to each.

Electronic Signature (type your name)

Today's Date

Electronic Signature of Parent/Guardian if under 18 years of age (type your name)

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