One moment please...
Alternative Break Application - Spring 2019
Contact Information
*

First Name
Last Name
*

They/Them/Theirs
*

*

*

*
*

(mm/dd/yyyy)
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Emergency Contact Information

First Name
Last Name
*

*

Health and Wellness
We want you to be aware that this is a very busy and intense peer travel experience in Houston. This is not a vacation, we will be working hard to help people who need us. We will be doing physical labor to help with ongoing supervised rebuilding efforts, including some construction. 15-hour program days are the norm. Please be honest with us as we want to ensure your health and safety during the trip. That being said, there are a few questions that we need to ask you regarding your health and welfare in order for us to best accommodate you on this trip. All personal information is kept private and is only used by your trip administrator to evaluate any needs you may have, and to make any arrangements for special accommodations on your trip.
*

*
*

If no, write n/a.
*
*

We require all participants to have health insurance for the trip. If you do not have health insurance please contact emily@sfhillel.org.
*

Essays
Tell us about yourself!
*

*

*

*

PLEASE REVIEW THE TRIP WAIVER AND AGREEMENT HERE.

*