SCORE INTERNATIONAL

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 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 # ### - ### - ####
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

SCORE INTERNATIONAL

$90 per person, per night.

FOR MINORS

MEDICAL RELEASE SECTION

POLICY & PROCEDURE

PAYMENT DUE 30 DAYS BEFORE DEPARTURE.