SCORE INTERNATIONAL
GAP Visitor Application
Each traveler must complete this application.
CHECK ALL THAT APPLY
ENCOUNTER WEEK
GRADUATION CELEBRATION
$90 per person, per night.
Cost includes: Lodging, meals, in-country ground transportation and trip insurance.
HOW MANY NIGHTS?
HOW MANY PEOPLE IN YOUR GROUP?
GAP STUDENT YOU ARE VISITING
FIRST NAME
*
MIDDLE
LAST
*
ADDRESS
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Curacao
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
PRIMARY PHONE #
*
###
-
###
-
####
EMAIL
*
BIRTHDAY
*
MM
/
DD
/
YYYY
BIRTHPLACE
*
Select a Choice
*
U.S. CITIZEN
OTHER
U.S. PASSPORT #
STATUS
SINGLE
MARRIED
SPOUSE IS GOING ON TRIP
GENDER
*
MALE
FEMALE
ARE YOU 18 OR OLDER?
*
YES
NO (Parental Consent Form is needed, download from our website, must be notarized and carried with you to the airport)
FOR MINORS
Parental Consent Form
Minor's Parent Email
Minor's Parent Phone #
###
-
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-
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MEDICAL RELEASE SECTION
EVERYONE MUST COMPLETE THIS SECTION.
EMERGENCY CONTACT NAME
*
EMERGENCY CONTACT PHONE #
*
###
-
###
-
####
PLEASE LIST ANY MEDICAL ISSUES YOU MAY HAVE INCLUDING FOOD ALLERGIES.
PLEASE LIST ANY MEDICATION WE SHOULD BE AWARE OF HERE:
PLEASE LET US KNOW OF ANY HISTORY OF HEART PROBLEMS.
INSURANCE COMPANY:
*
GROUP #
*
POLICY #
*
POLICY & PROCEDURE
Policy & Procedure Manual
I acknowledge that SCORE International has my permission to make any decisions regarding medical emergencies on my behalf if I am unable to do so. I also agree with the terms in the Policy & Procedure for travelers.
*
I agree
Any additional information you would like to add?
PAYMENT DUE 30 DAYS BEFORE DEPARTURE.
To pay online:
PAY ONLINE
Do Not Fill This Out