2023 - 2024 Faith, Learning and Service Immersion Trip Registration Form

Mandatory Meetings:
TBD

Withdrawal Policy

A $200 deposit for International Trips and $100 deposit for Domestic Trips is required at the time of this Registration Form and is non-refundable should the participant decide to withdraw from the Service Trip. After the Registration date ends, if additional costs, such as airline tickets have been purchased, participant will be responsible for prepaid expenses.

*Greene County Habitat and Greene County Immersion are only $30. You have the option to pay in full OR pay a $15 deposit. Final trip payment will be due one week prior to the trip.
Name Name First Last
Class Status
Major
Service Trip
Date of Birth Date of Birth / MM / DD YYYY
Student Email
Cell Phone Cell Phone - ### - ### ####
Do you have a WU disciplinary record?
Residence Hall/Commuter
Room Number/On-Campus House
Will this trip be used to fulfill SLR 106?

All trips can fulfill the General Education Requirement in Service Learning (SLR 106)

Please check with your academic advisor to ensure SLR 106 fits your academic plan.

Credit for participation in service learning experience must be awarded during the same academic year of participation. If you are a graduating senior participating in a summer service trip, you must enroll in SLR 106. Nursing majors do not need to request credit since the requirement is covered by a senior nursing course.

Please note, due to COVID-19, Trips may be cancelled.
I understand that by selecting NO I will NOT RECIEVE SLR 106 Credit.

I understand that by selecting NO I will NOT RECIEVE SLR 106 Credit. Yes No
I understand that by selecting YES I will be enrolled in SLR 106.

I understand that by selecting YES I will be enrolled in SLR 106. Yes No
Method of Deposit Payment:

Method of Deposit Payment: Credit Card Cash - in the Center of Service Leadership Due the next Business Day of Registration Check - in the Center of Service Leadership Due the next Business Day of Registration (made payable to Waynesburg University with Service Trip name written in the Memo Line)
By submitting this form and a $200 deposit for an International Trip or a $100 deposit for a Domestic Trip, I understand that I am entering into a contractual agreement with the Center for Service Leadership, that this deposit is part of the total Service Trip cost and is non-refundable should I withdraw from the trip, and that I am responsible for paying for the trip fees or any expenses incurred on my behalf, should I decide to withdraw from the trip. All trip participants must have health insurance.

Required vaccines must be completed, proof of insurance and trip balance must be paid prior to trip departure.

By submitting this form and a $200 deposit for an International Trip or a $100 deposit for a Domestic Trip, I understand that I am entering into a contractual agreement with the Center for Service Leadership, that this deposit is part of the total Service Trip cost and is non-refundable should I withdraw from the trip, and that I am responsible for paying for the trip fees or any expenses incurred on my behalf, should I decide to withdraw from the trip. All trip participants must have health insurance.

Required vaccines must be completed, proof of insurance and trip balance must be paid prior to trip departure. I have read the above terms and understand the information.

2023 - 2024 Faith, Learning and Service Immersion Trip Registration Form

2023 - 2024 Faith, Learning and Service Immersion Trip Registration Form

Withdrawal Policy