BYU-Idaho2017Travels of the Apostles Religious Study Tour Application

Complete, sign, and submit this application and letter of intent to either:

►Bro. Boyd Baggett, Department of Religion, TAY 218, Rexburg, ID 83460-1510 (208) 496-3929 /

►Bro. Fernando Castro, Department of Religion, TAY 220, Rexburg, ID 83460-1510 (208) 496-3932 /

►Bro. Curtis Castillo, Department of Religion, RIG 210, Rexburg, ID 83460-1510 (208) 496-3964 /

Full Name______Gender: M or F (circle)

Preferred Name ______

Name as it appears (or will appear) on your passport______

Country Issuing Passport ______Number (if you have one) ______

Age____ Date of Birth______(DD/MM/YYYY) Citizenship (U.S., Canada, etc.) ______

E-mail (required) ______Phone (______) ______

Single or Married (circle)

If single, is there anyone with whom you have a boyfriend/girlfriend relationship who is also applying for this study tour? YES or NO (circle)

Served Mission: YES or NO(circle); If YES, where______

Have participated in another BYUI Travel Study Program: YES or NO (circle)

If yes, which program ______

Admitted to BYU-I: YES or NO (circle)

If yes: what is your BYU-I ID # ______

Tracks Attending: Fall/WinterWinter/SpringSpring/Fall

BYU-Idaho Address______

If No: What is your status? (Check)

____BYU-I graduate (either with an associate or bachelor’s) Year & semester of graduation ______

____BYU-Provo student

____ Attending other college or university; name of college ______

____Other; explain______

Academic Major______Academic Minor______

Year in College(circle): FRESHMAN SOPHOMORE JUNIOR SENIOR

Number of Credit Hours Completed To-date ______; Overall GPA ______

Short Answer: Why do you think we consider GPA as we are looking at applicants to spend a month in Europe studying Religious History? ______

______

______

Parent/Guardian Name______Phone (____) ______

Address______City/State/ZIP______

In case of emergency, notify (if different from parent/guardian):

Name______Relationship______

Address______City/State/ZIP ______

Phone (____) ______

STUDENT COMMITMENT

If accepted as a member of this program, I promise to:

1. Support and uphold the moral standards and ideals of the LDS Church.

2. Follow the behavior, dress, and grooming codes of BYU-Idaho.

3. Abide by the decisions of the tour directors in all matters pertaining to the tour.

4. Accept the will of the majority whenever a matter of choice presents itself.

5. Always be in a group of 3 or more while on tour (in the US or overseas).

6. Make payments by the deadlines outlined

I understand I may be sent home at my own cost if I fail to adhere to these regulations.

Signature of Applicant ______Date: ______

Signature of Parent/Guardian______Date: ______

(Participants under 21 or financially dependent upon parents/guardians must have parental/guardian approval.)

References

College Bishop: Name ______Tel (___) ______Email ______

Home Bishop: Name ______Tel (___) ______Email ______

Professor: Name ______Tel (___) ______Email ______

Assumption of Risk and Release Agreement

I know and recognize that participation in a Travel-Studies program conducted by BYU-Idaho is done on a voluntary basis without compulsion or coercion and is not a mandatory class requirement. I know there may be dangers and hazards associated with the tour and assume the risks associated with participation in the tour, including but not limited to: the hazards associated with travel, whether by land, sea, or air including airplane, auto, or bus crashes; being struck by a vehicle or suffering physical exertion; hazards of unstable governments and related potential violence; hate crimes; illness caused by food, water, heat, cold, altitude, or contagious disease; assault, theft, or robbery; trip cancellation or change in itinerary and travel plans; acts of God; any activity I decide to participate in during free time. I acknowledge that these hazards could cause physical or emotional harm or even death.

Knowing the risks, and in consideration for being permitted to participate, and as inducement to BYU Idaho to permit me to participate in this tour, I hereby, for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue and waive, release, and discharge BYU-Idaho, its agents, officers, and employees from any and all claims or liability for death, personal injury or property damage of any kind or nature, and any other claims whatsoever arising out of or in any way connected with my participation in this tour, even though liability may arise out of carelessness on the part of BYU-Idaho, including its officers and employees.

This release extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.

I have carefully read the general information and any additional written information concerning the program as furnished by the university. I hereby represent that I am qualified in all respects to apply for a BYU-Idaho travel study program and agree to all of the terms herein. I authorize the disclosure of my personal record file at the university, including transcripts and financial information, for the purpose of evaluating my eligibility for acceptance into the program. If for any reason my status at BYU-I changes prior to departure on the program, I will notify the travel study programs office.

MY SIGNATURE BELOW AFFIRMS THAT I HAVE CAREFULLY READ THIS ASSUMPTION OF

RISK AND RELEASE AGREEMENT AND THE OTHER TERMS; I UNDERSTAND ITS CONTENT AND PURPOSES, AND I VOLUNTARILY AGREE TO ALL THE TERMS SET FORTH ABOVE (signing constitutes a binding legal agreement).

Participant signature ______Date: ______

Parent/guardian signature: ______Date: ______

(Required if participant is under 21 or dependent on parent/guardian)

Student Health Form and Medical History

Legal Name: ______

(First) (Middle) (Last)

Participants must consider their stamina and health conditions in deciding if they can meet the physical and emotional requirements of a four-week rigorous travel schedule. Participants should be in a sufficient state of health to participate fully. We advise participants to have a physical check-up before registering for the program. Brigham Young University cannot be responsible for any illness that would occur on the tour. Persons with heart disease, high blood pressure, or other physical impairments that could hinder them from normal participation with the group should contact the tour director before submitting an application.

Persons who have surgery too close to the tour dates to recover fully (in the judgment of the physician and tour director) will need to withdraw so as not to jeopardize their healing process and impede the mobility of the tour group.

Your Health Concerns / Y / N / Your Health Concerns / Y / N / Your Health Concerns / Y / N
Allergies / Joint/Muscle Problems / High Blood Pressure
Asthma / Back Problems / Eating Disorder
Colitis / Heart Problems / ADD/ADHD
Diabetes/Hypoglycemia / Stomach Trouble/Ulcers / Schizophrenia
Hernia / Thyroid Problem / Claustrophobia
Hives or Rashes / Seizures / Dementia
Reactions to Drugs / Suicidal Thoughts / Acrophobia
Heat Reactions / Depression / Obsessive-Compulsive
Hearing Loss / Anxiety/Panic Attacks / PTSD

If you answered YES to any of the above questions, please explain:

______

Are you currently receiving counseling? YES or NO (circle)

Are you currently taking medication? YES or NO (circle)

If YES, please indicate what medication and if you will be taking it on the tour.

______

Other health issues: (Please describe)

______

Insurance

Brigham Young University Idaho has no funds to compensate for the loss, damage, or theft of luggage and/or personal belongings. Nor can we cover hospitalization or other medical expenses due to illness or accident. It is therefore the responsibility of each participant to acquire adequate health and/or travel insurance to guard against such expenses, or assume personal responsibility for such expenses.

Health Insurance company ______Policy No.______

Policyholder's name ______Group No.______

Consent to Treatment

I understand and agree that BYU-I will not have medical personnel available at the location of the program. I further agree that BYU-I personnel and students are granted permission to provide and authorize emergency medical treatment, if necessary, and that such actions are subject to the Assumption of Risk and Liability Agreement which I have signed and that they shall assume no responsibility for any injury or damage which might arise out of or in connection with such emergency medical treatment. In the event of my injury or illness, I also authorize BYU-I to select a physician(s) to administer surgical treatment or carry out such procedures as may be deemed necessary or advisable to diagnose and treat me during the course of my participation in the Religious History Tour program.

I freely give this medical information to my directors, knowing that they will keep it in the strictest confidence.

Participant signature ______Date: ______

Parent/guardian signature Date: ______Date: ______

(Required if participant is under 21 or dependent on parent/guardian)

Letter of Intent

Write a 300-word letter of intent explaining why you should be considered for admission in the European Religious History travel-study program. (You can either hand-write it on this page or type it and attached it as the last page of the application.)

Application does not automatically guarantee admission to the program. Only about 40 participants can be accommodated in each program. Admission is granted according to the relevance of the tour to students' academic objectives, program diversity, academic standing, and other program needs.