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Thailand
Service Corps Application Form
Please print,
complete and sign the application. Send by mail
to: Thailand Service Corps 10924 Walden Pond
Lane, EL Paso, TX 79934 Please enclose
a $200.00 deposit with your application.
This fee will be credited toward your final project fee cost. Any
questions regarding the application please e-mail us
at: tscatelp@aol.com or
telephone the TSC office at 1-915-249-2903 or 1-915-346-1252(m)
NAME: ______________________________________
GENDER: ___________
ADDRESS: _________________________ DATE OF BIRTH: __________
CITY/STATE/ZIP:
_____________________________________________________
E-MAIL ADDRESS: ___________________________
DAY PHONE: ___________________ EVENING PHONE:
__________________
PROJECT:
o
HEALTHCARE
o BUDDHIST CULTURAL
TRADITIONS
o EDUCATION
PROJECT
DURATION:
o 3
WEEKS
o 6
WEEKS
o 9WEEKS
DESIRED STARTING DATE: ___________________________
DO YOU HAVE ANY SPECIAL DIETARY NEEDS:
______________________________________________________________
(While
TSC will attempt to accommodate most dietary needs, TSC makes no
affirmation that it will meet the requirements of all dietary needs and
special arrangements may need to be taken by the participant in advance.)
PASSPORT DATE OF ISSUE AND PASSPORT NUMBER:
______________________________________
EMERGENCY CONTACT INDIVIDUAL:
_______________________________________________________
POLICIES:
PAYMENT
All payments may be made by electronic funds transfer (EFT), or by
personal, cashier's check or money orders. Please contact TSC for EFT
routing and account numbers.
1) All fees, in accordance with the published fee schedule, are due 60 days
prior to the originally scheduled program start date. A late fee charge of
$200.00 will be assessed if fees are not received by the due date.
2) TSC is a 501 (c) 3, non-profit corporation registered in the state of Texas. All fees paid
to Thailand Service Corps (TSC), to include the cost of your airfare, are
tax deductible; however, you are advised to consult with your tax advisor
to assure deductions are properly applied and requested.
PROGRAM FEE
The program fee provides: Airport pick up by a TSC agent, hotel basic room
costs, all meals, host accommodations, personalized project to include
placement with a host, daily in-country support (lodging, meals,
transportation to and from project site, local staff, volunteer
coordination, in-country coordinator), trip preparation ( communications,
planning, organizing, handbooks), in-country transportation, excursions
(when available) including a tour of Bangkok and a Jungle Safari,
administrative and in-country assistance costs, (volunteer coordination,
local staff, communications, telecommunications equipment, office expense,
transportation, community outreach, cultural exchange for Thai teachers or
medical staff to USA, program development, aid to hosts/schools/hospitals/Wats, legal assistance, liability, goodwill,
registration and licensing with Thai government agencies, marketing,
accounting, taxes, employee benefits, and text books), cellular telephone
for local or long distance calls.
The program fee does not provide: Air transportation to and from Thailand,
visa or passport fees, taxes, immunizations, beverages, internet use,
international or domestic phone cards for use with the hand phone, laundry
expenses, trip cancellation insurance, medical or emergency evacuation
insurance, any other expenses not listed above.
CANCELLATION
Cancellation of participation, by the
participant, must be delivered via certified mail to TSC and is effective
only upon receipt by TSC.
1) Cancellations Received Between 30 and 60 Days Before a Project Start
Date: Cancellations received no less than 30 days before an originally
scheduled project start date will entitle the participant to a 50% refund
of the program cost [or of payments made].
2) Cancellations Received 30 Days or Less Before a Project Start Date:
Cancellations received 30 days or less before the scheduled project start
date will require that the participant be charged 75% of the program fee.
3) Cancellations Received 15 Days or Less Before a Project Start Date: No
refund will be issued to a participant canceling 15 days or less before a
scheduled start date.
4) Cancellation During the Project: No refund will be issued to a
participant canceling once a project has started. However, you may
reschedule for a future project date.
5) Cancellation by TSC: In the event that TSC should cancel a project, TSC
will provide a total refund to the participant.
6) Delay of Project by TSC:
A) In the event that TSC should delay the start of a project based upon the
U.S. Department of State's issuance of a travel warning for Thailand,
TSC will hold your fees until the travel warning is lifted and then
reschedule you for the next available project.
B) In the
event that TSC should delay a project, after the project has started, based
upon the U.S. Department of State's issuance of a travel warning for Thailand,
TSC will refund to the participant that portion of the in-country remaining
funds.
TERMINATION
TSC reserves the right to expel anyone who is a danger to him/herself or
others who exhibits misconduct or who, in the opinion of TSC or its agents,
is unable for any reason to safely or satisfactorily complete the program.
In the event the participant is expelled by TSC, no refund will be given to
the participant and the participant shall surrender the participant's work
permit to TSC and exit the country of Thailand within twenty-four
hours following delivery of the notice of the expulsion.
RISKS
The participant, by signing this application and initialing next to these
provisions affirms the following statements and agreements:
______ I agree to travel and participate at my own risk.
______ I acknowledge that there are inherent dangers in traveling to and
living in Thailand
and the surrounding areas and I agree to travel and participate at my own
risk and agree to assume full responsibility for myself and property.
______ I understand that TSC and its agents, both domestic and
international, assume no liability for any personal harm or illness to
myself or for any loss or damage to any personal property that I may bring
to or purchase in Thailand
or the surrounding areas.
______ I,
my heirs and my personal representatives and assigns, hereby absolve TSC
and its agents and hold them harmless from any claim or demand that I, my
heirs and my personal representatives and assigns might conceivably assert
for any such harm, illness, loss or damage. It is my intent to be legally
bound by this statement. TSC CAN BE SUED FOR INTENTIONAL ACTS, GROSS
MISCONDUCT AND/OR GROSS NEGLIGENCE.
______ I understand that I am not required to participate in any activity
in which I do not feel comfortable, but that my decision not to participate
does not entitle me to a refund for any portion of the project fees.
______ I have or will assess my own personal needs by consulting with a
physician concerning immunizations, medical and dietary needs prior to my
project participation.
______ I agree to follow all applicable rules, policies and guidelines of
TSC whether made part of this application or not and whether published or
not. I further agree to follow all applicable rules, policies and
guidelines of the host families, as well as, the laws of the Country and
communities of Thailand
and surrounding areas and the United States of America.
CHOICE OF LAW
Texas law
applies to the performance of this Agreement. If any provision of this
Agreement is unenforceable or too broad to be enforced to its full extent,
then, that provision and the remaining provisions shall be enforced to the
maximum extent permitted by law.
ATTORNEY'S FEES
In the event of any legal proceedings wherein TSC is named a party by the
participant in contravention of this Agreement's terms, the prevailing
party shall be paid all costs of court and reasonable attorney's fees
associated with enforcing or defending the terms of this Agreement by the
other party.
TRAVEL INSURANCE
TSC does not require that you purchase either trip cancellation insurance
or medical/emergency evacuation insurance, however, TSC is not responsible
for loss or damage to the participant or the participant's property for
failure to do so.
I understand that by signing and submitting this Application that I am
agreeing to the requirements of TSC. I have read this agreement in its
entirety and I agree to its terms.
_____________________________________ ________
SIGNATURE
DATE
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