Elderhostel Spring Break Application

Thank you for your interest in Elderhostel Spring Break! The volunteer work done over this week helps protect and improve this wonderful U of I treasure.

Keep in mind:
• You must be able to perform physical activity outdoors. Some projects may require heavy lifting.
• Allerton Park is a drug and smoke-free facility.
• This program fills up, so apply early! Confirmations will be made via e-mail.

TO APPLY, fill in the following information and submit electronically. The deadline to apply is Friday, February 28th.

Your Name

First

Last

Phone Number*

Email Address*

Your Permanent Address*

Street, City, State, Zip Code, and Country (if different than USA)

Emergency Contact #1 Name*

First and Last Name

Emergency Contact #1 Phone Number*

Emergency Contact #1 Relationship to You*

Emergency Contact #2 Name*

First and Last Name

Emergency Contact #2 Phone Number*

Emergency Contact #2 Relationship to You*

Do you have any allergies, asthma, epilepsy or other medical conditions that our staff should know about?*

Do you have any special dietary needs?*

Do you have any other issues or concerns that our staff should know about?*

Why do you want to participate in the Allerton Spring Break program?*

What do you hope to get out of your week at Allerton?*

Gender (for rooming purposes)*

Male

Female

Date of Birth*

Roommate request

Shirt Size*

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Which group would you like to participate in? *

Group 1 – Sunday March 15th @ 4pm – Tuesday March 17th @ 4pm

Group 2 – Tuesday March 17th @ 4pm- Thursday March 19th @ 4pm

Group 3- ALL WEEK!

This field should be left blank

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Monticello, Illinois 61856

217 333 3287

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