Program Participant Online Enrollment

Registration Form - Step 1 of 11

Program Destination: *

Program Start Date: *

Program End Date: *

School/Organization Name: *

Personal Information:

Name: *

First

Middle

Last

Preferred name/ nickname:

Date of Birth: *

Gender: *

T-shirt size? (S- XXXL)

Passport Details:

Passport Number: *

Passport's Issue Date: *

Passport's Expiration Date: *

Passport copy: *

Click or drag a file to this area to upload.

Address Details:

Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone:

Cell Phone:

Participant's Email address:

Dietary restrictions or food allergies: *

Why do you want to participate in a BLV program? *

Is participant's age more than 18 years ? *

Parent/Guardian Information (If under 18):

Guardian's Name: *

Cell Phone:

Email address:

Emergency Contact Info:

Emergency Contact Name *

Emergency Cell Phone: *

Emergency Email Address: *

Please read this document carefully. Each Bright Light Volunteers' program participant and his/her parent/guardian must sign this document before the program begins. Without all of the appropriate signatures, the individual will not be permitted to participate in the program.

I understand that my participation in a Bright Light Volunteers service program is an opportunity for me to broaden my understanding of the world. Through my participation I will continue to develop cross-cultural awareness and understanding, and I will act to promote positive change in our global community. I understand the following rules and expectations of this program:

Rules and Expectations

Participant agrees to adhere, and abide by, all of Bright Light Volunteers’ policies and procedures.
Participants are to conduct themselves in a manner that does not disrupt or interfere with the program or jeopardize the safety of self or others.
Participant agrees to abide by all the laws, rules, regulations and policies of the host country, community or any organization involved with this program.
Participant agrees and understands that their participation in this program may be terminated at any time if they should engage in conduct that is harmful to themselves or others, jeopardizes the success of the program or violates the rules and regulations of Bright Light Volunteers and its community partners.
All participants must stay with the group. Wandering off without permission from both the On-site Coordinator and the Program Leader will result in dismissal from the program and the participant will be sent home at their own expense.
Participants will respect the culture and belief systems of the host community
Participant agrees and understands that if they are terminated from the program that they would be fully responsible for any and all costs connected to returning them to their point of origin. Furthermore, they agree and understand that they will not be eligible for any program refunds due to the termination.

I understand that an enjoyable and worthwhile program depends on my active and enthusiastic participation. I will follow all the rules and understand that breaking these rules will result in dismissal from the program and that I will be sent home at my own expense. I make the commitment to make this opportunity a great personal learning experience and contribute to the cause of helping others.

Participant Name: *

Participant's Signature *

Date *

Commitment of Parents/Guardian (If participant is under 18)

By signing your name, you are acknowledging that you understand, accept, and agree to the above agreements that your child has made with Bright Light Volunteers.

Printed Parent/Guardian Name (If participant is under 18) *

Guardian's Signature *

Date: *

I, the person signing this Release Agreement, now voluntarily enters into this Release Agreement ("Release") with Bright Light Volunteers. Bright Light Volunteers is a not for profit, charitable organization formed under Section 501(c)3 of the US I.R.C. that is committed to international student volunteering, uniting people and cultures through positive, sustainable change. We bring people together for the better because we believe we can teach and learn from one another We are dedicated the mission “bringing the world closer together, and making the world a brighter place.” Bright Light Volunteers seeks to reach these goals through its programs in different countries throughout the world. In order for Bright Light Volunteers to permit me to participate in the Program, I enter into this Agreement. In consideration of Bright Light Volunteers allowing me to participate in the Program, which I agree is full and adequate consideration, I now enter into this Release Agreement, fully intending that I will be legally bound by it.

I now agree on behalf of myself and my heirs, assigns, personal representative, and estate to expressly release and defend, discharge, and indemnify Bright Light Volunteers (its employees, officers, directors, agents, board members, volunteers, affiliates [including Bethel University], subsidiaries and assigns) for and from any personal injury or property damage related to or occurring as the result of my participation in the Program, or while traveling to and from the Program site. I further represent that I am 18 years of age or older, have the authority to execute this Agreement, and that I am not under guardianship, conservatorship or any other legal authority.

I recognize that the Program involves risks, both known and inherent risks and unknown or unanticipated risks. My participation in the Program could result in damage to or loss of my personal property and serious physical or emotional injury to me, up to and including death. These risks include but are not limited to risks involved in air and ground transportation, differences in living conditions, diet, water quality, pollution, climate, political stability, and crime control. I will experience a different cultural environment while traveling in the course of the Program, which may include different cultural stereotypes or expectations, sexual harassment, or other uncomfortable situations. While representatives of Bright Light Volunteers will make reasonable efforts under the circumstances to respond to any of my health care and personal safety needs, I understand that any care or protection provided may differ significantly from care or protection available in the United States. Other risks are described by the U.S. Department of State at: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1127.html.

All of these risks are listed as examples and I understand that listing these examples is not a limitation of the potential hazards. Bright Light Volunteers has not attempted to include an exhaustive list of the risks which I may encounter while participating in the Program. Knowing this, it is my intention for this Release to be interpreted as broadly as the law permits in favor of Bright Light Volunteers regardless of whether any particular risk which may result in an injury to me is specifically listed in this agreement.

If Bright Light Volunteers or anyone acting on its behalf incurs attorney’s fees and costs to enforce this agreement, I agree to pay those attorney fees, and to indemnify them from all such fees and costs. If any provision is found to be unenforceable or invalid, all of the other terms and provisions of this Release shall remain in full force and effect.

I certify that I have insurance to cover injury or damage I may cause or suffer while participating in the Program, or else I agree to bear the cost of such injury or damage myself. I further certify that I have no medical, physical, emotional conditions, which could interfere with or compromise my safety during the course of the program, or else I am willing to assume and bear the cost of all risks that may be created directly or indirectly by any such conditions.

This Release is a contract with legal consequences. By signing this document, I acknowledge that if personal injury or property damage occurs during participation in this Program, I may be found by a court of law to have waived my rights and any rights of my heirs, assigns, personal representative, and estate to maintain a lawsuit against Bright Light Volunteers on the basis of the claims I am releasing. I have had sufficient opportunity to read this document in its entirety. I understand this Release Agreement and I agree to be bound by its terms.

Printed Participant’s Name *

Participant’s Signature *

Date *

Printed Guardian’s Name (if participant is under 18) *

Guardian's Signature *

Date *

Bright Light Volunteers is a not for profit, charitable organization formed under Section 501(c)(3) of the US I.R.C. that is committed to international student volunteering, uniting people and cultures through positive, sustainable change. We bring people together for the better because we believe we can teach and learn from one another. We are dedicated the mission “bringing the world closer together, and making the world a brighter place.” Each participant is required to read and sign this Drug and Alcohol Policy before participating in a program. As a participant in a Bright Light service program, I understand that I am serving as an ambassador for Bright Light and for our home community. Therefore, I am expected to abide by the laws, regulations, and customs of the host country, community, institution, and program. I will conduct myself in a responsible and mature manner at all times.

Alcohol Use

Although there may be no minimum drinking age in the host country, the customs regarding alcohol use may be very different from the ones in the United States. I am aware of the following circumstances that might tempt me to misuse alcohol while abroad: a mistaken impression of how alcohol is used in your new surroundings; cheaper costs in some countries; a lower minimum drinking age; more lenient laws against drunkenness; or a desire to experiment or fit in. However, during my orientation I was well informed that alcohol misuse and abuse is not acceptable anywhere in the world and will not be tolerated on a Bright Light Volunteers service program. Violation of local laws and/or BLV policies related to alcohol use will result in:

Parental notification and university/school notification
Possible dismissal from the program, at participant’s expense

Drug Use

(Adapted from the U.S. Department of State's Travel Warning on Drugs Abroad) See http://www.state.gov/r/pa/prs/ps/2008/feb/101133.htm Also, www.travel.state.gov Bright Light has a zero-tolerance policy regarding the possession, use, manufacture, production, sale, exchange or distribution of illegal drugs by participants in the Bright Light service programs, including, but not limited to, the BU Global Service Learning Program. Violation of this policy will result in:

Parental and university/school notification
Immediate dismissal from the program, at participant’s expense
Academic withdrawal from the University for the semester in progress, if applicable

NOTE: Each year several thousand Americans are arrested overseas. Many of the arrests are on drug-related charges. If you choose to use illegal drugs abroad, there is very little that anyone at Bright Light Volunteers, our educational partner, Bethel University, or the US Government can do to help you if you are arrested.

You are operating under the laws of the host country and the regulations of the local institution. Neither the U.S. government nor the home institution will be able to secure your release should you be arrested. It is your responsibility to know the drug laws of a foreign country before you go. Some laws may be applied more strictly to foreigners than to local citizens; therefore, do not assume that just because local people are using drugs, it’s acceptable for you to use drugs.

Here is what the U.S. Consulate CAN and CANNOT do if you are arrested on drug charges:

The U.S. Consular Office CAN:

visit you in jail after being notified of your arrest
give you a list of local attorneys (The U.S. Government cannot assume responsibility for the professional ability or integrity of these individuals or recommend a particular attorney)
notify your family and/or friends and relay requests for money or other aid - but only with your authorization
intercede with local authorities to make sure that your rights under local laws are fully observed and that you are treated humanely, according to internationally accepted standards
protest mistreatment or abuse to the appropriate authorities

The U.S. Consular Office CANNOT:

demand your immediate release or get you out of jail or the country
represent you at trial or give legal counsel
pay legal fees and/or fines with U.S. government funds

If you are caught using illegal drugs by a BLV program leader, you will be immediately dismissed from the service program. You will be sent home at your own expense. If you are caught by local authorities, it could mean:

Interrogation and delays before trial, including mistreatment and solitary confinement for up to one year under very primitive conditions
lengthy trials conducted in a foreign language, with delays and postponements
weeks, months or life in prison (some places include hard labor, heavy fines, and/or lashings), if found guilty
death penalty in a growing number of countries (e.g., Malaysia, Pakistan, and Turkey)

Although drug laws vary from country to country, it is important to realize before you make the mistake of getting involved with drugs that foreign countries do not react lightly to drug offenders. In some countries, anyone who is caught with even a very small quantity for personal use may be tried and receive the same sentence as the large-scale trafficker.

Once you leave the United States you are not covered by U.S. laws and constitutional rights.
Bail is not granted in many countries when drugs are involved.
The burden of proof in many countries is on the accused to prove his/her innocence.
In some countries, evidence obtained illegally by local authorities may be admissible in court.
Few countries offer drug offenders jury trials or even require the prisoner's presence at trial.
Many countries have mandatory prison sentences of seven years to life without the possibility of parole

Drug And Alcohol Policies *

I agree to the Terms and Conditions

I have read these Alcohol and Drug Policies and agree to comply and support these regulations with full understanding that disciplinary actions will be made against me should I choose to violate this contract including possible dismissal from the program including required immediate return home at my own cost. I have been informed of the possible hazards and legal consequences of alcohol and drug consumption and the tendency for some students to engage in such behavior during international or domestic academic traveling programs.

Printed Participant’s Name *

Participant’s Signature *

Date *

Printed Guardian’s Name (if participant is under 18) *

Guardian's Signature *

Date *

Each Bright Light Volunteers’ program participant or parent/legal guardian (if under 18) must complete this Medical History Form before the volunteer will be allowed to participate in program activities. All medical information obtained is voluntary, but it may be necessary to be provided to a medical service provider in case of a medical event in a foreign country. By providing this information, I give consent for representatives of Bright Light Volunteers to provide a copy of this form to a medical service provider, if and when necessary during my time with the program

Participant Name *

Date of Birth *

Insurance Card: *

Click or drag a file to this area to upload.

Explain any “YES” answers on the next page

Have you had a medical illness or injury since your last check-up/physical? *

Have you ever passed out during or after physical activity? *

Have you ever had chest pain or difficulty breathing during or after physical activity? *

Have you ever experienced racing of your heart or a feeling of skipped or irregular heartbeats? *

Has a physician ever restricted your participation in sports for any heart/lung related problems? *

Have you been diagnosed with Epilepsy or have you ever had a seizure? *

Do you have Diabetes? Insulin dependent? *

Are you under a physician’s care for any acute or chronic condition or physical or mental illness? *

Are you currently taking any prescription or non-prescription medications or inhalers? *

Do you have any allergies? (Seasonal, drug, food, environmental, insect, skin, etc.) *

Do you have asthma? Do you or have you required the use of an inhaler? *

Have you ever required the use of an Epinephrine Auto-Injector (Epi-Pen)? *

Note: If you have ever used an inhaler for any reason, even if you have not used it recently, you should bring it with you on the trip for your safety as being in a different climate/country may exacerbate your condition requiring the use of your inhaler

Please explain any “yes” answers on the previous page. Additional written clearance may be required from physician or nurse practitioner prior to departure.

Please list/explain any other medical issues of which program coordinators should be aware.

Please list all prescription and over-the-counter medications that you are taking and/or will be bringing on the program, including inhalers and Auto-Injector Epinephrine Pens. Note: All prescription and over-the-counter medications that you are bringing with you must be in the original, properly-labeled bottles.

	Name of Medication	Dosage	Frequency	Prescribed For?

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

By signing below, I give my permission for representatives of Bright Light Volunteers to act as my health care agent in the event that an emergency arises, no other agent is available, and I cannot make healthcare decisions for myself.

Printed Participant’s Name *

Participant’s Signature *

Date *

Printed Guardian’s Name (if participant is under 18) *

Guardian's Signature *

Guardian's Date *

I hereby give my consent to Bright Light Volunteers to photograph, film, videotape and then use, reproduce, and publish said images of me for promotional purposes.

I agree that photographs/negatives, film, or videotapes thereof shall constitute the sole property of Bright Light Volunteers, with full right of disposition in any manner whatsoever, including the right to publish on our website (https://www.brightlightvolunteers.org).

I hereby release Bright Light Volunteers and its legal representatives and assigns from any and all claims whatsoever in connection with the use, reproduction, publication of the images thereof

Printed Participant’s Name *

Participant’s Signature *

Date *

Printed Guardian’s Name (if participant is under 18) *

Guardian's Signature *

Date *

These Program Enrollment Conditions (PECs) are valid for ALL Bright Light Volunteers’ (BLV) Global Service Learning (GSL) programs commencing in March 2020 and beyond and are subject to change without notice. The most current Booking Conditions at the time of your program commencement will apply, which are available at brightlightvolunteers.org/faq and in our Enrollment Packet.

What is included in the program contribution?

$500 non-refundable deposit
All accommodations & meals
Community service project funding
On-site, trained BLV representative
On-site, bilingual community host leader
All on-site transportation (excludes airfare)
All cultural activities
24-7 stateside support All community donations
Tuition for dual-enrollment college course offered online via BLV educational partner, Bethel University.
Certificate of Global Citizenship administered by BLV educational partner Bethel University
Presidential Volunteer Service Award- Bronze Level

The above all apply to all programs unless otherwise noted in your BLV GSL program contract.

What does the non-refundable deposit include?

Processing and logistic services performed by BLV staff
Deposits for services in our host communities

What is not included in the program contribution?

Any applicable baggage-handling fees imposed by airlines
Passport, visa, and reciprocity fees or any other fees associated with entry or exit from a particular destination
Gratuities, if desired
Extra beverages and snacks outside of the three daily meals provided by BLV
Rooming supplement (if applicable)
Expenses caused by airline rescheduling, cancelations, or delays caused by the airlines,bad weather, or any other event or circumstance beyond BLV’s control.

College credit

Bright Light Volunteers, in partnership with Bethel University, uses a methodology called ‘global service learning’ which combines international community service with experiential and online learning. This approach has proven to create culturally aware, global leaders and citizens who understand their place in the world and their ability to effect change both at home and abroad. On post-GSLC surveys, 100% of our high school participants report that they have a deeper knowledge of the interconnections between the United States and the rest of the world. They also report having a better understanding of and appreciation for other people and cultures as a result of their GSLC experience. Through this innovative program, participants will:

Enroll in a five-week, online course, GST 140 Global Service Learning and Citizenship (GSLC), through Bethel University, for three, transferable, credit hours. With guidance from UNESCO global citizenship education, the GSLC course equips participants with the broad knowledge and functional skills necessary to become culturally competent, global citizens and leaders. Via the online course, participants gain exposure to the history and culture of the host country, preparing them well for the experience of cultural immersion and exchange. Participants improve their understanding and critical thinking about global issues and the interconnectedness of different countries and populations. They become familiar with UN Global Goals and develop an understanding of how their service supports the development of a more peaceful and sustainable world.
In addition to the online course work, in-country lectures, small group discussions, and reflection activities are implemented to facilitate deep learning among our participants. Reflective activities include focused journaling and discussions with trained BLV/BU staff about program projects, accomplishments, challenges, cultural differences, community impact, sustainability issues, and personal/professional growth.
The cost of tuition for the course is included in the program contribution. However, there is a separate enrollment process.

Rising, Tennessee, high school juniors and seniors, eligible for TSAC Dual Enrollment Grant
$0

Rising, Tennessee, high school juniors and seniors, ineligible for TSAC Dual Enrollment Grant
$300

Auditing fee for Global Citizenship Certificate
$300

Graduating Tennessee high school seniors and college students
$693

Rising, out-of-State, high school juniors and seniors
$500

Graduating, out-of-state, high school seniors and college students
$693

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