Name
*
Exactly as it appears in your passport
First Name
Last Name
Gender
*
Female
Male
Non-binary / other
Email Address
*
Contact Phone Number
*
(###)
###
####
Mailing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mental and Physical Conditions and Limitations
*
Please describe any mental or physical health conditions or other limitations that may impede your ability to participate in any activities described in the program itinerary, carry your luggage, engage in activities in a hot and humid environment, etc... Otherwise indicate "None".
Dietary Restrictions
*
Please list any dietary restrictions you have. Make special note of allergies. Otherwise indicate "None."
Rooming Preference
Provide names of people you would like to room with, if applicable.
Passport
*
International travel requires a valid passport (book, not card) valid for 6 months after the program ends. We recommend using the expedited service, as processing time is usually much longer than what is indicated by the passport service.
Passport Number
Passport Expiration Date
Your passport should not expire for 6 months after the date of your return to the US. You will not be allowed to travel by customs officers otherwise.
MM
DD
YYYY
Birthday
*
MM
DD
YYYY
Emergency Contact
*
Please provide the name of your emergency contact.
First Name
Last Name
Emergency Contact Phone Number
*
(###)
###
####
Emergency Contact Email
*
Language Proficiency
*
Please indicate your degree of fluency in the language of your destination country.
Arrival Date
MM
DD
YYYY
Arrival Time
Hour
Minute
Second
AM
PM
Departure Date
MM
DD
YYYY
Departure Time
Hour
Minute
Second
AM
PM
Insurance Company Phone
*
Insurance company emergency phone number
(###)
###
####
Participant Code of Conduct
*
As a Program Participant, I acknowledge that my participation in the Program will be subject to the expectations outlined below:
*Abide by all local laws and Learn from Travel policies including those related to COVID-19, which may include mandatory vaccination, testing, mask wearing, and social distancing
*Follow the instructions of guide and Group Leaders at all times
*Do not use illegal drugs. Assume all drugs are illegal.
*Do not consume alcohol in excess. Program Participants who are minors, based on local law, may not consume alcohol. Alcohol consumption, if permitted by Group Leaders for Program Participants who are of legal local drinking age, must not be excessive. Excessive use of alcohol, leading to visible inebriation, will not be tolerated, and is grounds for dismissal.
*Sexual harassment, defined as unwelcome sexual advances, requests for sexual favors or unwanted sexual attention, including but not limited to obscene jokes, lewd comments, sexual depictions, repeated requests for dates, touching, staring, or other sexual conduct, is grounds for dismissal. Report any sexual harassment to the group guide or Group Leader(s).
*Respect local norms with regard to dress, language, and interaction with local people.
By entering my name below I agree to abide by the Learn from Travel Code of Conduct as outlined above:
Additional Comments or Additional Special Requirements
How did you hear about this program?
Thank you for providing your information.
If you did not have some of the information available at the time of completing this form, please send it to info@learnfromtravel.com or submit another form at a later date.
Should we have any questions we will get in touch with you.
