PTE Facilitator Application Form
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<strong>Facilitator</strong> <strong>Application</strong> <strong>Form</strong><br />
Connecting, Involving, Empowering<br />
Welcome to the Peace Train Europe project! A new and innovative way to connect,<br />
involve and empower youth in the local realities through diverse hands-on projects<br />
whilst travelling through and experiencing the various cities that make up Europe!<br />
*Please read the entire form and the Peace Train Guide first before filling it out. You may contact us for further<br />
information if anything is unclear or missing from the form at peacetraineu@gmail.com<br />
• Values Required:<br />
- Open-mindedness<br />
- Flexibility and adaptability<br />
- Readiness to act and react<br />
- Mental and physical endurance<br />
- Interdependent Capability (able to work as a team but capable of taking own initiative)<br />
• Requirements:<br />
• At least 21 years of age<br />
• Preferably a European citizen<br />
• English fluency recommended<br />
• A team player<br />
• Experience as a staff and/or a leader in a CISV International program desired<br />
• A keen observer<br />
• Capable of remaining neutral<br />
• Attendance during the Training Days is a must<br />
Family Name<br />
Forename<br />
Date of Birth<br />
CISV Chapter<br />
Previous CISV Experience<br />
*Dietary requirements<br />
*Allergies<br />
Applicant´s Email
Telephone Number<br />
Attitudes, Skills and Knowledge to offer to the project<br />
Personal Reasons for participating in the Project<br />
Applicant´s Signature<br />
Sources for the letters of Recommendation<br />
“Travel is fatal to prejudice, bigotry, and narrow-mindedness,<br />
and many of our people need it sorely on these accounts. Broad,<br />
wholesome, charitable views of men and things cannot be<br />
acquired by vegetating in one little corner of the earth all one's<br />
lifetime.”<br />
- Mark Twain<br />
1. Authorization for the facilitator to participate in the Peace Train Europe<br />
I understand that joining the Peace Train Europe Project does entail having a set of responsibilities in respect to<br />
the Project, the participant group, their families and to my fellow facilitators.<br />
I am also aware that a background check is necessary and I will provide a current one not older than 6 months<br />
together with my application.<br />
2. Authorization and appointment of the adult facilitator<br />
I accept the role as an adult facilitator present as a temporary guardian of the participant for purposes of<br />
decisions regarding medical treatment and safety of the participant in the period stated. I will act in accordance<br />
to Privacy and other laws that govern temporary guardianship of youth.<br />
3. Authorization for unsupervised free movement
I will allow the participants to move freely in different settings with at least two other participants under the<br />
condition in certain circumstances that allow it with an emphasis on my good judgement. It is not related to the<br />
travelling periods wherein strict supervision is required.<br />
4. Insurance<br />
I hereby declare that I am insured with the policy number with attached copy of the Insurance: which will be<br />
provided by the Organizing Team. The insurance would cover: Medical, Financial and Pay for Damage issues.<br />
5. Permission to use of images, art and or written work<br />
I agree that the project requires a thorough documentation and that would mean that the facilitators and<br />
participants will be subjects and authors of various media. There will be several social media outlets running,<br />
published work in local press, a published book in the end, and a fully edited video. The participants and<br />
facilitators will be identified by first name or nickname, age and nationality. I fully understand that since the<br />
documentation is extremely important, I give my full permission to the use of images, art and or written work<br />
wherein I am either subject or authors of.<br />
6. Permission to partake in swimming and other water activities, first Aid and Life Saving Swimming skills.<br />
I understand that I may have to partake in swimming or other water activities and I give my own estimation of<br />
my swimming capabilities.<br />
Poor Fair Good<br />
Life Saving Swimming Skills<br />
I am capable and sure in administering lifesaving<br />
skills in the realm of swimming<br />
First Aid Skills<br />
I am capable and sure in administering first aid skills<br />
Yes No Yes No<br />
* Please provide certificates to demonstrate them.<br />
7. Medical Disclosure<br />
I agree to give full accurate and current medical disclosure of my person, in English with the contact details of<br />
my physician, with an attached Health <strong>Form</strong> when necessary. This may be evaluated by the Organizing Team<br />
before the start of the Project and will be treated in accordance to medical privacy laws.<br />
8. Arrival after the start of and/or early or late departure from the Peace Train Europe<br />
The planning team and the facilitators understand that sometimes there are unavoidable conflicts in life and,<br />
for extenuating circumstances, flexibility can be offered, so long as it does not negatively impact the trip nor<br />
the participant’s safety. It will be made sure that all delegates arrive/leave at a time that works for the trip<br />
logistics and as close as possible to each other, timewise, to make it easier for the Peace Train Europe or local<br />
chapter members to pick them up from or drop them off at the airport, train or bus station.<br />
Delegates can arrive/depart a day or so early due to extenuating circumstances (ie a final exam) if and only if:<br />
•they have plans for pick-up or drop-off and a homestay, if arriving early or departing late;
•it is acknowledged that neither the local association, the Peace Train Europe organizing team nor Peace Train<br />
facilitators are responsible for the participant’s welfare if they arrive early or depart late;<br />
•pre-arrangements (including travel details, names & contact information of person with whom they are<br />
staying, etc.) have been approved by the local association’s risk manager.<br />
9. Direct pick-up of a participant to and from Peace Train Europe<br />
The Peace Train Europe facilitators are responsible for the safety of the youth on the program from the time<br />
the child arrives at the start destination until the participant departs at the end destination. If I give written,<br />
detailed consent ahead of time, the participant can be released to the care of a responsible adult who can<br />
show government-issued photo identification matching the information in the written consent.<br />
10. Attendance during the Training Weekend<br />
I understand that I need to attend the training weekend and not doing so may compromise my application. If I<br />
am physically unable to participate due to work/scholarly reasons, I will communicate it as soon as possible in<br />
order to organize an alternative training possibility.<br />
*Please do refer to the <strong>PTE</strong> Project Guide for any questions.<br />
** Do send a digital copy of the filled form to peacetraineu@gmail.com<br />
I hereby give my consent to participate in the Peace Train Europe and agree to all the Terms and conditions<br />
Date<br />
Place<br />
Emergency Contact’s Email<br />
Emergency Contact Number<br />
Applicant’s Signature