European School Summer Camp 2021 in Georgia

Annex 1. Applicant’s Consent Form

NOTE: In case if applicant will be 18, or older than 18 years old, at the time of applying for the program, this form should be filled by
applicant, signed, scanned and sent to the email.

As applicant – Mari Sirbiladze_________________________________________(Applicant’s Name, Surname), I certify and agree

to all of the following:

1. The information on online application is complete, true, and accurate and that all relevant information about myself has
been reflected in the application.
2. I agree to participate in the European School Summer Camp 2021 in Georgia.
3. I agree to travel to and from Georgia and go on trips related to the Summer Camp Activities.
4. I am aware that I must inform organizers regarding my decision, to accept the invitation or not, in an adequate period of
time, as required in the invitation email.
5. I agree with the Code of Conduct of the Camp.
6. I agree to obtain international medical insurance for myself, and am aware that it will not be reimbursed by organizers.
7. I understand that I may be dismissed from the Summer Camp for behavior and academic issues that LEPL „Youth Agency”
considers inappropriate or detrimental (as it is defined in the Code of Conduct of the Camp) and am aware that I will be
responsible for arranging and financing by backway route.
8. I understand and agree to attend and participate in all modules and sessions during the Summer Camp.
9. I understand that I should maintain positive relations with camp staff and organizers.
10. I agree, that LEPL „Youth Agency” is responsible for providing me with adequate housing and that I will be accommodated
in a camp dormitory with other participants (3-5 participants) and agree to treat it with thought and respect.
11. I agree to keep the lines of communication open and communicate with respect, to inform LEPL „Youth Agency” of any
problems, concerns, comments or successes that occur over the course of the program period.
12. I understand that I will only be provided with an international, economy class ticket, including 20KG baggage allowance.
Participants are not allowed to make any changes (date, route, class, luggage allowance etc.) to the ticket provided by Lepl
Youth Agency.
13. I understand that No expenses will be reimbursed by the organizers outside of Georgia. Such as Airport transfer,
Guardian’s/ Parental consent form to travel to Georgia and back, Travel insurance, Health certificate from medical
institution, Test for COVID-19 and etc.
14. I understand that I must follow all the regulations and restrictions caused by COVID-19. This may include: Present a
negative PCR test result taken within the past 72 hours; Present a COVID-19 vaccine certificate confirming receipt of two
full doses of the vaccine; Not to travel abroad, for 14 days, before coming to Georgia; Complete the passenger information
form when arriving to Georgia and etc.
15. I agree that my photos and videos will be published by the organizers.

I have read the information above, understand them, and agree to follow them. I understand that if I break the Code of Conduct, I
will be asked to leave the camp.
M. Sirbiladze
Applicant’s Signature

Applicant’s Name, Surname/ Date: mari sirbiladze 03.27.2021

This project is supported by the European Union and is implemented by Lepl „Youth Agency“
პროექტს ევროკავშირის მხარდაჭერით ახორციელებს სსიპ „ახალგაზრდობის სააგენტო“