Costa Rica 2024

Escape The Shape Trip Student Form

Please fill out the form below so we have all the necessary information for bookings and your safety on the trip. If you do not currently have a passport you may list TBD for the passport questions and email us the passport information once you receive it.

Name

As it appears on your passport

First Name

Last Name

Middle Name

As it appears on your passport (If Applicable)

Nickname

If Applicable

Preferred Pronouns

Gender

Date of Birth

YYYY

Phone Number

(###)

###

####

Are you vaccinated against COVID-19?

If you answered "No," are you planning on being fully vaccinated against COVID-19 by May 2024?

Grade Level

Please list what grade you will have completed by June 2024

Interests/Hobbies

Are you a U.S. citizen?

Yes

If not, what country do you have citizenship in?

Country of Passport Issuance

Passport Number

Passport Expiration Date

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone Number

(###)

###

####

Dietary Restrictions

Please list anything you are allergic to, you cannot eat, or you need to have with you such as an Epi Pen

Physical Restrictions

Please list anything that may restrict you from physical activities.

Is this your first trip outside of the U.S?

Yes

Please list up to 5 of your favorite musicians to listen to below.

Is there anything you would like us to know?

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Costa Rica Trip Student Form

Costa Rica 2024

Escape The Shape Trip Student Form

En Root Travel | HBCU Alumni Travel Group

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