HU Athletics Thailand 2024 Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete and return.

Email *

Last Name

First Name *

Middle Name *

Street Address (Home) *

City, State *

Zip *

Email *

Phone (xxx-xxx-xxxx) *

Passport Number *

If no passport yet please indicate date of application *

Emergency Contact Name *

Emergency Contact Relationship to You *

Emergency Contact Phone *

Allergies (Food, environmental, medical) If any, do you/will you carry an EPI pen? *

Medical Conditions other than allergies (heart condition, metal implants, diabetes, asthma, etc.) Include any medications you regularly take and would need to bring with you on the trip. *

Major *

Special Skills/Talents (ex: singing, instrument, dance, art) *

Do you have the Covid Vaccine? (This is not required at this time. It just impacts the entry process and transit documentation.) *

YES

NO and I do not plan to get it.

NO but I plan to get it.

Are you willing to get the required vaccinations? Typhoid, Hep A&B, Yellow Fever (YF only if you have been in parts of Africa within the last 9 months), and be up to date on routine vaccinations like DPT, Chickenpox, etc. Flu vaccine is optional. *

Yes

Other:

Tell us a little about your faith journey. (There is no right answer. We just desire to get a feel for where you are at so that we can work to meet your spiritual needs.) *

Do you consent to sharing personal information/data to team leader, viewable by UB Global administrator? (Medical, Passport #, address, etc) *

Yes

If no, please explain

Have you been convicted of a felony? *

Completely Confidential, information will not be shared

Let's Chat About This

Do you consent to a limited criminal history background check? (Approx $15, online. Only checks for violent crimes, drug offenses and sexually based offenses. Results are COMPLETELY confidential and will not be shared with anyone outside of Shaana Robrock. S. Robrock will not see any details, just if there have been convictions. Juvenile offenses will not be flagged. (NO coaches, teammates, HU admins or UB Global will be privy to these results. Again, 100% confidential.) *

Yes

Other:

Are you committed to adhering to travel safety policies and procedures set forth by team leader and coaches? (no alcohol or drug use, etc) *

Yes

Other:

Are you committed to attending and participating in all training sessions? *

Yes

Other:

Are you committed to fulfilling your financial obligations? *

Yes

Other:

Do you release Shaana Robrock, Huntington University et al, UB Global and The Phoenix Alliance from all liabilities? *

Yes

Other:

Comments/Questions *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of The Phoenix Alliance. Report Abuse

Forms