Before you fill out the following application, please consider the costs associated with a JustWorks trip beyond the participation fee. These include, but are not limited to the following:
Flights
Participants are responsible for purchasing their own airfare. The cost to fly to Haiti from the United States is generally $300–$600. We encourage you to talk to family, friends, and community members about donating frequent flyer miles.
Vaccinations and medications
While the tetanus vaccination is the only one we require, we strongly recommend that every participant get the full range of vaccinations recommended for Haiti by the Center for Disease Control and Prevention.These vaccinations, if not covered by your health insurance, can cost up to $1,000. We also very strongly recommend obtaining Malaria medication before participating in a trip to Haiti. If you will be doing fundraising or publicity, please refer to the organization running the trip as the UUSC-UUA JustWorks Program and include the URL www.uusc.org/justworks.
To complete this registration form by phone, please call 617-301-4326, between 10 a.m. and 4:30 p.m. EST on weekdays. If a staff member in the UUSC College of Social Justice is not available, we will do our best to return your call on the same day.
4. Address *This question is required
14. Are you a US Citizen? *This question is required
16. Are you a member of UUSC? *This question is required
17. Please list a personal reference to whom you are not related. *This question is required
The following is a general health questionnaire. This information will be kept private but may be shared amongst the trip organizers, the participant-selection committee, and those in UUSC's emergency response team. All personnel are bound by UUSC policies to keep your health information private.
21. Do you have any of the following or have you ever experienced issues related to them? If you answer Yes to any, please add notes in the next question. *This question is required
24. A tetanus vaccination is required for JustWorks trips, due to the nature of the construction work that we will be performing. Have you had a tetanus vaccination or booster in the past nine years? If not, you must receive one before the beginning of the trip and notify UUSC in writing. *This question is required
28. Please enter your health insurance provider information.
If you do not have this information readily available, please fill in what you can remember and submit the form. You can email your complete health insurance information to justworks@uusc.org when you have it available.
29. First Emergency Contact *This question is required
30. Second Emergency Contact *This question is required
31. Would you like us to periodically update these people with non-emergency information like trip status and timelines (e.g., arrival at work site, departure from Port-au-Prince)?
Recommendation: Rather than write your essay responses directly into the online application, we recommend you compose your response in a word processor, and when you are finished, cut and paste it into the field provided when the rest of the form is ready to be submitted. This will reduce the chance of lost data that sometimes happens with web-based forms.
Participant Statements
JustWorks Participant Policies and Statements
In consideration of the opportunity afforded me to volunteer in the Unitarian Universalist Service Committee JustWorks Program (hereafter referred to as "UUSC"), and in light of the aims and purposes of the service provided by UUSC in organizing this project, I agree to participate in the trip; and I waive any right or cause of action arising as a result of my participation in said project from which any liability may or could accrue against UUSC, its officers, employees, and directors, either individually or collectively. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or damage to my property sustained in connection with my activities for the trips. Therefore, I agree to assume all risks.
I understand UUSC assumes no responsibility for the loss of damage to personal equipment or property brought to the work site by a participant or staff member.
I understand the participants must have working knowledge of spoken and written English. I grant permission for UUSC to use any quotations, photographs, or videotapes of me during the trip for promotional purposes.
I understand that opportunities to participate in UUSC JustWorks trips are limited and applications are necessarily competitive. Applicants will be accepted for participation based on their commitment to social-justice work as demonstrated by their words and their actions; the skills, attitudes, and life experiences they bring to the experience; and the limitations of any physical or medical conditions that may affect their own safety or those of others given the conditions and circumstances of the specific trip for which they are applying. I understand that UUSC has the right to accept, deny acceptance, or withdraw acceptance of any applicant at any time up to and including the trip itself, at its sole discretion. In the event UUSC withdraws acceptance, UUSC will make all reasonable efforts to reimburse applicants for any nonrefundable expenses related to trip planning and preparation (e.g., airfare).
If any sentence, phrase, paragraph, or section of this waiver is found to be invalid or ineffective by any court of competent jurisdiction, such decision shall not affect the validity or the effectiveness of the remaining portions of this participant statement or any part thereof.
By submitting this application, you agree to receive communications from UUSC.
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Please click the Submit button below to send this Application in.
