Alternative Spring Break Application

General Information

Name: Date of Birth: _____/____/_____ Age: Class Standing (circle one):

Freshman Sophomore Junior Senior

USC ID:

Graduate

Young Professional

Other

Major(s):

Minor(s):

Do you speak another language? If so what language? (there is no language requirement)

Contact Information

Email Address: Phone (Best number to reach you):

Emergency/Health Information

Emergency Contact : Address: Phone (home):

Relationship:

Phone (cell):

Please list any medications currently being taken:

Please list any allergies (medications and non-medications):

Please list any health (including physical) concerns and/or special dietary needs:

Insurance Provider: Primary Insured:

Phone: Policy #:

Turn in Application to the Catholic Center by 6PM on Thursday, October 17th, 2013 Only completed and signed applications will be accepted.

Additional Information

How did you find out about our trips: Website Friend Poster/Flyer CC Staff Information Session Other____________________________________________________________ If 21, are you willing to drive a rental vehicle Yes Do you know First Aid? Are you CPR certified? Yes Yes No No No

Have you participated in an ASB with the Catholic Center before? Yes No If so, which trip and when?______________________________________________ ____________________________________________________________________ ____________________________________________________________________ Have you participated in an ASB with USC before? Yes No If so, where did you go?_________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Are you willing to take on extra responsiblities (i.e. creating group social events, being a team captain during the actual trip) as a trip program coordinator? Yes No Is this your last chance to go on a ASB trip? Yes No

Our Goal is to select a team composed of: 50/50 male/female mix Mix of grade levels We will take into consideration if it is your last chance to go on the trip Priority will be given to current USC Students & Students Registered at the USC Caruso Catholic Center

Turn in Application to the Catholic Center by 6PM on Thursday, October 17th, 2013 Only completed and signed applications will be accepted.

Las Marias, Puerto Rico We can take up to 12 people including 1 staff member on this trip. We are working with Plenitude Inicitivas Eco-educativas http://www.plenitudpr.org/ Total Cost: $1,500 total per student. Cost includes food, shelter, and all transportation. Cost per student: $1,000 for Las Marias, Puerto Rico trip. Type of service: Some examples of service activities include: developing and improving the infrastructure a tour teaching center (road maintenance, painting, fence-building, etc.); working with food production (work in the green house, weeding and planting garden beds, clearing new areas for planting, harvesting and washing crops, etc.); working with natural building projects (natural plastering, building with alternative building techniques such as super adobe and rammed earth); and community outreach projects (community gardens, school gardens, and misc. agricultural projects). El Paso, Texas We can take up to 12 people including 1 staff member on this trip. We are working with Annunciation House, http://www.annunciationhouse.org/ Total Cost: $1,000 total per student. Cost includes food, shelter, and all transportation. Cost per student: $700 for the El Paso, Texas trip. Type of service: The objective of the Border Awareness Experience (BAE) is to facilitate face to face meetings and encounters between BAE participants and people and groups on both sides of the Border. It intends to raise consciousness in the first world about the issues facing the peoples of the third world and the effects of unjust economic policies on their lives. It is an opportunity to listen to different perspectives and opinions about issues such as immigration, economic development, human rights, and social justice. It seeks put a face on the immigrant, the factory worker, the refugee, and the Border Patrol Agent. Some typical service activities include cleaning the house - kitchen, grease trap, bathrooms, dorm rooms - where the immigrants live, doing laundry, and sorting and organizing food and clothing pantries. San Juan Bautista, California We can take up to 12 people including 1 staff member on this trip. We are working with Community Links International http://commlinksorg.drupalgardens.com Total Cost: $900 total per student. Cost includes food, shelter, and all transportation. Cost per student: $600 for the San Juan Bautista, California trip. Type of service: Can include environmental service such as organic composting and gardening, reforestation, recycling, greenhouses, composting latrines, solar ovens, litter campaigns, etc; Community-Based Education - with children, youth and their families focusing on environmental issues; and catalyzing fair trade opportunities for local producers. The financial difference will be made in fundraising. Students selected to go on this trip must contribute to all of the fundraising activities of the Catholic Center for ASB.

Turn in Application to the Catholic Center by 6PM on Thurs. October 17th, 2013. Only completed and signed applications will be accepted.

Please Read This Thoroughly! Before reading, keep in mind that this is a Catholic service trip. This trip is intended to follow Catholic values of social justice. Initialing next to each one, and sign the bottom portion of the sheet. Your signature at the bottom signifies you will abide by these rules.

General Guidelines: ___ I understand the Catholic center promotes an alcohol/drug free policy on ALL ASB trips for all participants regardless of their age. This trip will be a dry and chaste trip (i.e. no alcohol, drugs, or sexual activity will be tolerated in any way at any point in time for the duration of the trip). I understand that I could be sent home at my own expense if I violate the alcohol/drug policy. I agree that any image taken of me while on any trip or during ASB related events may be used for Catholic Center promotional material. This trip will include interactions with the local community. Therefore, you are expected to go on this trip with a respect for other cultures. The service project we are participating in requires physical labor. Anyone is welcome to participate despite any physical ailments, provided that we are informed ahead of time. Also, any level of physical ability is greatly appreciated and should not discourage anyone from applying. Please check with your doctor or the University Health Center for the appropriate inoculations (i.e. shots) before travelling to Puerto Rico, El Paso and/or San Juan Bautista. You are responsible for the proper documentation (i.e. drivers license or state issued ID, travelling health insurance, signed liability waiver - see attached form.) For safety and security reasons, everyone is to stay with the group unless explicitly said otherwise by a coordinator. If this rule is violated, I understand that I could be sent home at my own expense.

___ ___ ___ ___

___ ___ ___

Involvement, I will: ___ ___ ___ ___ ___ ___ participate in the entire trip. I understand that I may not arrive late or leave early and that the Catholic Center cannot accommodate individual travel requests. attend ALL pre-trip orientation meetings. participate in ALL activities during the trip, including the volunteer service, meals, meetings, and reflection sessions. participate in ALL fundraising projects. fundraise with the group and individually in order to cover the remainder of the costs. respond in a timely manner (within 96 hours) to communications from the ASB trip coordinators. I acknowledge that I could potentially forfeit my spot on the ASB trip if I fail to meet this expectation. Turn in Application to the Catholic Center by 6PM on Thursday, October 17th, 2013. Only completed and signed applications will be accepted.

Payments, I will/I understand: ___ ___ pay a NON-REFUNDABLE deposit of $350 for Puerto Rico and $300 for El Paso and/ or San Juan Bautista that will secure a spot on my trip. This fee will also be deducted from the overall cost of my trip. payment schedule is as follows:
Puerto Rico $350 $350 $300 $1,000 El Paso, TX $300 $200 $200 $700 San Juan Batista, CA $200 $200 $200 $600

1st payment (deposit) 10/24, 6pm 2nd payment 11/14, 6pm 3rd payment 1/23, 6pm Total w/deposit

___ ___ ___

if the NON-REFUNDABLE deposit is not turned in by the payment date, 10/24, at 6pm, I forfeit my spot to the next person on the waitlist. my participant fee includes will help cover food, lodging, group cultural activities, and travel fees, as specified by my ASB coordinators. The fee does NOT include: baggage fees for air travel trips, travel Insurance, or extras such as snacks. my participant fee will not be partially refunded to me for any aspects of the trip in which I do not participate.

Withdrawal, I will/I understand: ___ if I withdraw from the ASB trip after January 23rd, 2014 I understand that I will still be responsible for paying the remaining balance of the total cost of the trip. NO EXCEPTIONS.

I understand the time and commitment my participation on al alternative spring break entails, and agree to abide by all of the guidelines listed above. _________________________ Student Name (print) _________________________
Trip

_________________________ Student Signature _________________________

Date

Turn in Application to the Catholic Center by 6PM on Thursday, October 17th, 2013. Only completed and signed applications will be accepted.

RELEASE OF LIABILITY This release is in consideration of my being permitted to participate in the following Event scheduled for ________________________________________________________: (insert date(s)) __________________________________________________________________________. (insert name/description of Event) I recognize there are risks of injury, sickness, loss and other costs and expenses associated with participating in this Event. I hereby agree to assume all risks that may occur as a result of participating in this Event. I hereby release the University of Southern California (USC) and __________________________________________________________________________ (insert name of student club) and their respective officers, directors, trustees, employees, faculty, administrators, members, agents and representatives, as applicable, from any and all claims, causes of action, losses, liabilities, costs, and expenses (including reasonable attorneys fees), arising or resulting from or in connection with my participation in the Event, including as a result of their negligence, if any. If I am injured, I agree to assume any financial obligation, either through my health insurance, or through some other means, for any medical costs which I incur. USC and/or the others released herein assume no responsibility for any medical expenses, injury, or damage suffered by me in connection with the Event. This release shall be construed in accordance with, and governed by, the laws of the State of California. I acknowledge that this release is a complete release of liability given in consideration for being permitted to participate in the Event, and that I have read this release and understand its meaning and effect. I further agree that my assignees, heirs, parents, guardians, and legal representatives will not make any claim against, sue or attach the property of USC and/or the others released herein for any loss or damage resulting from my participation in the Event. I am aware of the potential dangers incidental to participating in the Event, that this is a release of liability, a waiver of my legal right to collect damages in the event of injury, death or property damage, and a contract between me and those released herein, and I sign it of my own free will. Date: Signed: ___________________________________

Please PRINT name here: ____________________________________________________ IF PERSON SIGNING RELEASE IS UNDER EIGHTEEN, PARENT/GUARDIAN SIGNATURE IS REQUIRED BELOW: Parent/Guardian Signature: _______________________________ Date: _______________ Print Name of Parent/Guardian: __________________________________________
USC File 10.1.2012

Short Answer Questions The responses to the following questions will help us tailor the formation of the trip to everyones needs. There are no right or wrong answers. Please answer all of the questions below. 1. Which service trip is your first preference, Puerto Rico, El Paso or San Juan Bautista, CA? Why do you want to go on this particular trip? If you are selected to go on the trip that is not your first preference would you still like to attend?

2. What does social justice mean to you?

3. What do you expect to learn/gain out of this trip?

4. What will you contribute to ASB? What unique skills, knowledge or qualities do you have that will enhance the group?

5. Have you ever been on a service trip (local or abroad) before? If so, describe the trip and your overall experience.

6. Describe your understanding of the social teachings of the Catholic Church?

7. Tell us a fun fact about yourself.

Checklist To give us (this information is due on 1/23/14 unless otherwise indicated): Copy of government issued id Copy of USC ID Card ______ Signed USC Waiver, Release and Indemnity Agreement - DUE 11/14/13 ______ Signed Archdiocese of Los Angeles Release Form - DUE 11/14/13 Filled out and signed application - DUE 11/14/13 Proof of insurance What to bring: Toiletries Sturdy work shoes Sleeping bag Pillow (or you can use a sweatshirt to save space) Climate appropriate clothing Happy attitude Money for extra expenses (souvenirs and extra food not covered by the Social Justice Committee) What not to bring: Guns, alcohol, sharp objects, aerosols (please follow TSA regulations) Bad mojo Expensive belongings Deadlines (make sure to keep track of these): 10/17/13 Application Due 10/24/13 First Payment Due 10/28/13 1st Meeting for El Paso & San Juan Batista (6pm-7pm) 10/31/13 1st Meeting for Puerto Rico (6pm-7pm) 11/14/13 Second Payment & ALL Paperwork Due 11/18/13 2nd Meeting for El Paso & San Juan Batista (6pm-7pm) 11/21/13 2nd Meeting for Puerto Rico (6pm-7pm) 1/23/14 Third Payment Due 1/27/14 3rd Meeting for El Paso & San Juan Batista (6pm-7pm) 1/30/14 3rd Meeting for Puerto Rico (6pm-7pm) 2/10/14 4th Meeting for El Paso & San Juan Batista (6pm-7pm) 2/20/14 4th Meeting for Puerto Rico (6pm-7pm) 3/10/14 5th Meeting for El Paso & San Juan Batista (6pm-7pm) 3/13/14 5th Meeting for Puerto Rico (6pm-7pm) 3/15/14 - 3/22/14 Spring Break Trips to Puerto Rico, El Paso, and San Juan Batista. Social Justice Contact Information: Mayra Moran, Alternative Spring Break Coordinator (714) 883-3723 mayramor@usc.edu Rosie Chinea Shawver, Campus Minister (310) 963-9783 rosie@catholictrojan.org Jamie Zamora, Social Justice Chair (951) 733-8283 jamiebrooke17@gmail.com