Poetice International

Immersion Trip Application

Immersion Trip Application

IDENTITY

Please select your birthday from the date picker or manually format your birthday MM/DD/YYYY

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TRIP PREFERENCES

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BASIC MEDICAL INFORMATION

While a complete physical is not required for participation in this trip, it is encouraged. It is our hope and your responsibility to ensure your own physical condition is satisfactory for participation in this trip.

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UPLOADS

WAVIER & RELEASE FORM
Please upload a scan of your signed Wavier & Release Form (find link under DOWNLOADS section)

PASSPORT
Please upload a PDF / JPG scan of your passport. If you have not yet received your passport, please email it to trips@poetice.org as soon as possible. (*file must be less than 1MB in size)

IMMUNIZATION RECORD
Please upload your up-to-date immunization record. To ensure that you have all the required immunizations for travel, please refer to the link above in 'Important Information'.

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EMERGENCY CONTACT

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AGREEMENTS & OBLIGATIONS

By submitting this application, I understand that upon review & acceptance, I am responsible for my airfare and trip cost as communicated to me by Poetice International as well as obtaining a passport and necessary immunizations, completing a waiver release form, providing up-to-date immunization records, and adhering to Poetice deadlines.

By submitting this application, I understand that, if I do not raise and submit the necessary funds by the final due date, my flight will be cancelled and I will not be able to participate in the program.

By submitting this application, I understand that, should I need to withdraw from this trip for any reason, I am still responsible for any expenses that have already been incurred on my behalf by the date of my withdrawal and that, because funds can not be returned for any reason, any remaining funds that were donated on my behalf will be disbursed to other trip participants and/or programs at the discretion of Poetice International within Poetice's current fiscal year.

By submitting this application, I understand that that all donations that are given to Poetice by me or on my behalf can NOT be returned in any form for any reason. In the event that I raise more than is necessary to fully cover the cost of my own trip, funds will be dispersed to other trip participants and/or programs at the discretion of Poetice International within Poetice's current fiscal year.

Confirmation of identity and providing truthful information.

IMPORTANT INFORMATION

Please keep in mind that you cannot save this application once you start it, so be sure to complete and scan any necessary uploads prior to starting your application. 

WAVIER & RELEASE FORM - In order to submit this form, you must upload a completed Waiver & Release Form (download wavier form below). 

PASSPORT - If you have a passport, please upload it. If you have not yet received your passport, please email a copy of your passport to trips@poetice.org as soon as possible. 

IMMUNIZATIONS - Please visit the Center for Disease Control (CDC) website to review all necessary immunizations for the country you intend to travel to. If your immunizations are up-to-date, please upload a copy of your immunization record.  If your immunizations are not up-to-date, please email a copy of your record to trips@poetice.org once you have received the recommended immunizations .

VISIT THE CDC TRAVEL SITE NOW

Downloads