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PLF Volunteer Online Application Form

20 August 2012

Ponheary Ly Foundation Volunteers

Please complete the details below as they appear on your passport.

Surname/Last Name:

First and Middle Names:

Your Email

Your Age

Your Gender

Your Current Occupation

Dates available to work with us:

Home Address

Street Address:

City/Town/Village:

Province/State:

Post Code/Zip Code:

Country:

Passport

Number:

Nationality:

Place and Date of Issue:

Expiration Date:

Emergency Contact

Emergency Contact (Name):

Street Address:

City/Town/Village:

Province/State:

Post Code/Zip Code:

Country:

Phone Number:

Email Address:

SEXUAL RELATIONSHIPS WITH CHILDREN

I understand that the Ponheary Ly Foundation is against sexual relationships with children and I confirm that I have never engaged in sexual relationships with children. I authorize the Ponheary Ly Foundation to make any investigations it deems appropriate to verify this. Further, I understand that if I appear to be engaging in such conduct I will be dismissed and reported to the authorities in Cambodia and in my home country.

I agree to the statement "Sexual Relationships with Children" above:

Contract with Volunteers and Visitors

1. I, in full recognition and appreciation of the dangers and hazards involved in such activity, do hereby agree to assume all risks and responsibilities surrounding my participation of this trip to Ponheary Ly Foundation Schools, on the date described above. I do hereby release and hold harmless Ponheary Ly Foundation (PLF) , its Trustees, Officers, Directors, Faculty and Employees, and participants from and against any and all liabilities to the undersigned, his/her dependents, assigns,participants from and against any and all liabilities to the undersigned, his/her dependents, assigns, personal representatives, heirs and next of kin for any and all damages, expenses (including attorney fees) claims, judgments, actions or causes of action as a result of any loss or injury to the person or property, including death which the participants listed below may sustain or suffer during or arising out of activities of the above described event and during transportation to and from such event whether caused by negligence of PLF, of persons active on its behalf or otherwise.

2. I understand that Ponheary Ly Foundation does not, in any manner, serve as principal, agent, or partner of any travel agent or commercial carrier which may provide services or to the participants. I have read and understand this release and voluntarily sign the document and participate in this trip.

3. In the event of injury to the undersigned, or any family participants listed above, I hereby authorize Ponheary Ly Foundation or representatives thereof to admit me or any member of my family to a facility for emergency medical treatment as may be deemed necessary to our health or welfare.

4. I hereby consent to whatever medical treatment is deemed necessary. I, on my behalf, and on behalf of my heirs, successors, assigns, and personal representatives, hereby release Ponheary Ly Foundation , its trustees, officers, faculty and employees from any and all claims arising from my admission to such facility or from such treatment administered by such facility.

5. I declare that all parties are participating in this visit solely at our own risk and indemnify Ponheary Ly Foundation (PLF) its Trustees, Officers, Directors, Faculty and Employees, and participants in respect of any claim arising out of our visit.

6. I understand that we will have to cooperate fully with the hosts of the school and the PLF and their employees and will diligently comply with all associate rules regarding safety.

I agree to the statement "Contract with Volunteers and Visitors" above:

Insurance

I understand that I will be required to carry traveler's insurance that includes medical evacuation while I am volunteering. A copy of this document must be forwarded to "volunteer@theplf.org " 1 week prior to arrival. I understand that failure to produce such paperwork will cause me to be removed from the volunteer schedule.

Areas of Interest

Which program(s) are you most interested in? Why?

Do you have any special skills, hobbies, or passions that could be relevant to our classroom needs?

Previous Experience

Have you traveled/worked/volunteered in "developing" countries before? If so, where? What did you do?

Questions

Why do you want to be a PLF Volunteer?

Can you think of any detrimental aspects of voluntourism?

How did you find out about Ponheary Ly Foundation?

If you are volunteering with other people, please list their names here.

Are you a native English speaker?

Do you have an ESL Certificate?
(not required)

Cost of being a Volunteer

  • Lodging in Siem Reap at Seven Candles Guesthouse: $20 per night
  • Transportation to and from school each day roundtrip: $15
  • A PLF T-shirt to wear to class: $5 per shirt
  • Teaching Materials: Approximately $5 to $15

Notes:

If there are two of you teaching in the same class, traveling to the school together and sharing a room, this cost would be for two people.

Expenses will be collected from you in Siem Reap in cash on the first day of your placement and are usually non-refundable.

Please email us if you are staying longer than 3 weeks. Costs for lodging will be reduced in that case. If you have made some other agreement with PLF about housing/transport costs (such as in the case of a long term stay) note them here (optional):

I agree to the statement "Cost of being a Volunteer" above:

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