Radical Escape - Application form

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This is an online application form for the training course Radical Escape that will take place in the Czech Republic from 11th to 20th March 2020. We are looking for youth workers, educators, NGO members ONLY residing in Slovenia, Slovakia, Italy, Malta, Estonia, Latvia, Spain or Czech Republic. The training course is available for participants aged 18+. The application is open until January 15th. Selection of participants will be made by 20th of January the latest.

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First name *

Surname *

Country of residence *

Name of the organization you represent *

Sex *

Male

Female

Date of birth *

YYYY

Nationality *

Home address *

Town *

E-mail *

Phone number (with international code) *

Contact in case of emergency (name, surname, relationship, phone number) *

Special dietary requirements

Other special needs (all relevant information concerning your health or any special needs – allergies, mobility restrictions, medical needs)

Your occupation

Your level of English (5 means fluent, 1 means you do not understand almost anything).

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Do you consider yourself as a youth worker/ youth leader? *

Yes

Please briefly explain your experience with the topic of game-based learning, escape rooms and international mobility projects.

Please briefly explain why you would like to be part of this training course, what you expect to learn and how you plan to use the learning.

I hereby declare that I have entirely read and understood the project description, infopack and reimbursement rules. *

Yes

I hereby commit myself to participate in the whole process of this project, meaning in the 100% of the work programme. Failure to do so might result in non-return of my travel expenses or even withdrawal from the project activity. *

Yes

I am aware that I am responsible for carrying out preparatory tasks asked by the organizers as well as dissemination activities after the training course. *

Yes

I am aware that obtaining a health and a full travel insurance are my own responsibility and at my own expense. I understand that the information I have provided on my special needs does not remove my own personal responsibility for ensuring my own health. *

Yes

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