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Health and Travel Information
Applicant Information





Medical and Emergency Information

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Travel Information


mm/dd/yyyy

Program leaders will pick you up from the airport or bus/train station if you are arriving by plane, train or bus. If you are traveling by car, we will give you the address where to meet us.
What is your flight/bus/train arrival time (or when you expect to arrive at the program location if arriving by car)?






Program leaders will drop you off at the airport or bus/train station if you are departing by plane, train or bus.
What is your flight/bus/train departure time (or when you expect to depart from the program location if travelling by car)?





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


1. I have applied and intend to participate in a program offered and/or coordinated by Unitarian Universalist College of Social Justice (“UUCSJ”) in Cambridge, Massachusetts, a program of the Unitarian Universalist Service Committee, Inc. (“UUSC”) operated in association with the Unitarian Universalist Association (“UUA”).

2. Deposits and Refunds - My deposit and payment for this program will be used toward the costs of travel, food, lodging. Deposits will not be refunded after the application deadline for this program. Balance payments will not be refunded less than 30 days before the beginning of the program. I agree to reimburse UUCSJ for any expenses incurred on my behalf in connection with this program. I accept responsibility for any additional costs incurred during the program. If the program is cancelled, I understand I will not be reimbursed for any of my costs beyond my participation fee.

3. Risks of Travel - International Travel, especially in the developing world, poses risks. These can include but are not limited to, the hazards of travel by various means of conveyance; the hazards of politically unstable areas, the dangers of civil disturbances and war; the forces of nature; unfamiliar or different terrain, language, climate, food and drink, customs, social and sexual mores, safety practices and regulations, communications, criminal activity, law enforcement activity, disability access, road conditions, driving practices, disease risks, lack of sanitary food and water; acts or omissions of UUCSJ, UUSC or UUA and/or agents, employees, officers, trustees, directors, associates, affiliated companies, subcontractors, or cooperating agencies or organizations (collectively, “Associated Persons”); and accidents or illness in places without access to medical facilities, transportation, and/or means of rapid evacuation or assistance. I understand that it is my responsibility to research and evaluate the risks I may face in this UUCSJ program and I voluntarily assume any risk and liability. I assume all risk posed by this program, including personal injury, illness, property loss or damage or death. I release, discharge and agree to indemnify and hold harmless UUCSJ, UUSC, UUA and all Associated Persons from any liability or loss related to this program.

4. Rules - I agree to abide by all rules and regulations of UUCSJ and its staff, along with the laws at the place(s) of the program. I agree to act in a manner which does not adversely affect my health, safety or welfare or those of others. Failure to do so may result in expulsion from the program, being sent home at my own cost, and forfeiting program fees. I agree UUCSJ has the right to do this and will reimburse UUCSJ for costs associated with expulsion from the program and early travel home. I understand that use of recreational or illegal drugs, possession of weapons or sexual harassing behavior are explicitly prohibited during this program.

5. Early Departure - If I leave this program before it’s completion, I agree that I will notify the program leader in writing in advance and take full responsibility for my well being. I will be responsible for my own costs, including travel and will forfeit my program fee. 

6. In case of Emergency - UUCSJ will notify the person(s) I have listed as emergency contacts in my registration. If I am unable to make medical decisions for myself, a UUCSJ representative may make those decisions on my behalf. I am solely responsible for costs of medical treatment during or resulting from the program.

 

*3. 7. Medical Disclosure - I understand that I assume full responsibility for any undisclosed medical or emotional issues. If I do not make a medical or physical need known at least 14 days before the program begins, this may delay or cancel my participation in the program.

8. Photo, Video and Quote Release - I release the UUCSJ the right to use any photos or videos taken during the program for any purpose, internal or external to UUCSJ and its parent organizations. Any quotes of mine taken from the program, my application or evaluation thereof may be similarly used.


9. Invalidity. Should any of the provisions of this Agreement and Release, or portions thereof, be found to be invalid by any court of competent jurisdiction, the remainder of this Agreement and Release shall nonetheless remain in full force and effect. This Agreement and Release shall be construed under the laws of the Commonwealth of Massachusetts.


10. I understand that UUCSJ staff will not be responsible for administering my medications, and that I will be responsible for taking them in accordance with the above instructions. 


11. I understand that I may have access to over-the-counter medications, such as analegesics and antihistamines, which I will be able to utilize at my own discretion. 





Applicant is under 18

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