Apply to Join a Team

ICARE - Because Every Life Matters

Thank you for taking the time to complete this form.

This Project Application must be completed to participate in a project in connection with INTERNATIONAL CONSULTANCY AND RESOURCE ENTERPRISE (ICARE) and/or other organizations working in partnership with ICARE for a project in the Gansu Province of China. Completing this Project Application will begin the application process. This is not a guarantee of space availability or approval for participating on a team. A member of ICARE will respond to your application shortly.
Team Trip: *
Name: *
Email: *
Phone: *Alt. Phone:
Address:
Street: *
Street 2:
City *
State / Province: *Postal Code (Zipcode): *
Country of Citizenship: *
Passport Number: *
( or HK / China Card Number )		Date of Birth: *
( yyyy/mm/dd )
Occupation: *Gender: *
Professional or Other Relevant Certifications: Do you speak English? *
Have you been to China before? *
( Include date(s) and purpose(s) of visit(s). ) 		Do you speak Mandarin Chinese? *


Emergency Contact Information:
Name: *Phone: *
City: *Country: *
Relationship: *


On what Team(s) are you applying to participate?
Teams: *


Can you commit now that if you are accepted and participate on the medical team, that you will arrive in Lanzhou by 1:00PM on Sunday, June 16, and that you will stay for the entire medical team project, departing June 22 or later (i.e., you will not be arriving late or departing early)? (i.e., you will not be arriving late or departing early)?
Commitment: *


Please state the reasons why you would like to participate on this team?
Reasons: *


Please tell us how you learned about ICARE. If you heard about ICARE from a person (friend, colleague, acquaintance, family member, etc.), tell us their name here. Also, please tell us if you (or if a friend, colleague, acquaintance or family member) have joined an ICARE team in the past..
ICARE: *


Our medical teams are often physically challenging and our team members often need to serve in rough conditions, including:
  • Rough roads for travel
  • Long hours of work for six days straight with minimal breaks (plus occasional team meetings in the evenings)
  • Working and walking on uneven terrain
  • Using local latrine-style toilets with no running water, during the hours of our village clinics
  • Sharing local village food for meals, etc.
  • Helping to load and unload medical team supplies from our supply trucks to place in each work station
Will you be able to work and serve under these conditions?
Conditions: *


Please state any concerns that you might have (such as physical limitations, dietary requirements, or other accommodations that are necessary for your participation).
Restrictions: *

Other remarks:
File to Attach:
PROMISES AND RELEASE:
I understand and agree that as a participant on the team with ICARE and/or its partner organizations, I take upon myself certain responsibilities. I promise that I will conduct my affairs during the trip with integrity. I understand that we will be serving members of poor communities with different cultures and ways of life. I agree that I will respect each person, and show them love and acceptance, regardless of their background and regardless of any behavior that they may display in response to our acts of love. I agree that I will not engage in any actions that will tarnish or reflect negatively on the reputation of ICARE or bring offense to China or the local community. I promise and agree that:
  • I have read and agree to the process and terms of the document entitled “IMPORTANT NEW CHANGES TO THE TEAM APPLICATION PROCESS”.
  • I have read and I will fully adhere to “ICARE MEDICAL TEAM CODE OF CONDUCT.”
  • I will not take photos/video of any children without permission from an ICARE staff member.
  • I understand that I am not permitted to distribute religious or political material on this trip. Therefore, I will bring to the attention of the ICARE staff any material that I may have brought from my home country dealing with religion and politics, or any other material that might be offensive to the people or government, and I agree to follow the ICARE Staff’s instructions regarding any such material.
  • I will not publish any articles, photos or videos regarding my trip without prior permission from the ICARE Project Leader.
  • I agree to abide by all trip rules, and the direction of the ICARE Staff. I understand that my failure to follow such rules and directions may result in termination of my participation in the trip and I will be responsible for any additional costs that may be required to terminate my participation (such as return airfare, etc.).
RELEASE OF LIABILITY AND ASSUMPTION OF RISK:
In consideration of being allowed to participate on this trip, I hereby release and agree not to hold ICARE and/or its partner organizations, or any Director or Officer thereof, liable or responsible for injury or loss to myself of any kind, including, but not limited to, bodily injury or illness, emotional distress, death or economic loss that I may sustain, for any reason or cause, during or arising out of this trip and/or project. I understand there are inherent risks in an international trip such as this one (including, but not limited to, those listed above), and I voluntarily assume any and all risk associated with my participation on the trip and its related activities.
ELECTRONIC SIGNATURE:

Please type your name below, to certify as your Electronic Signature of Agreement.


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