In Their Shoes: Application Form

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Youth Exchange
Zagreb - Croatia
May 3-11, 2021 (travel days included)
Application deadline: 14.04.2021

Webpage: https://babilontravel.eu/projects/erasmus/in-their-shoes-youth-exchange-in-zagreb/
Info pack: https://babilontravel.eu/wp-content/uploads/2021/01/Info-Pack-2-In-their-shoes-2.0.pdf

Please fill out the form using ONLY the Latin alphabet, without diacritics. Fields marked with * are mandatory.

First name: *

Last (Family) name: *

Gender: *

Female

Male

Prefer not to say

Date of birth: *

YYYY

City of birth: *

Country of birth: *

City of residence: *

Country of residence: *

Phone number: *

Please include country code, like: +40123456789

E-mail address: *

ID Card Passport number: *

The document you will use during the journey to Croatia

Your level of English: *

Poor

Basic

Good

Very good

Fluent

How many Erasmus+ projects did you attend? *

None

1-3

4-10

More than 10

You apply to the youth exchange as: *

Youngster with special needs (impairments like physical, mental, emotional), age 14-30

Youngster with fewer opportunities (social, economic, geographical), age 14-30

Youth leader, age 18+

Accompanying person, age 18+

In case you apply as a youngster with special needs, you are:

Visually impaired

Hearing impaired

Light mental/emotional disorders

Physical impairement

Other:

In case you apply as a youngster with fewer opportunities, these are:

Economic obstacles

Social obstacles

Geographic obstacles

Other:

What is your motivation to participate to this project? *

Do you have any special needs, dietary requirements, allergies or anything else that the host organisation should know about? *

In case of an emergency, who should we contact on your behalf? *

Name, phone number and e-mail address

In case you would like to add something, here is the right place:

Conditions of Participation: *

I will commit myself to participate to all activities, including preparation meetings and dissemination, as described in the info pack;

I confirm that I will arrange and pay for my own travel expenses and visa (if required), but that these costs will be reimbursed to me, up to set limits, after my successful attendance of the activities, as described in the Info Pack;

I understand that I am responsible for obtaining my own travel and/or health insurance and that the cost of this is NOT covered by the project;

I agree that submitting information to you about my special needs does not remove my own personal responsibility for ensuring my own health and safety;

I authorize the host organization and its partners to publish (in whatever form and by whatever medium they choose, pictures, videos, etc.) information about the activities, results and my participation therein.

Required

Data Protection (GDPR) *

In compliance with the GDPR I hereby authorize you to use and process my personal details contained in this document which will not be used for commercial purposes.

Required

THANK YOU

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