Home Who we are What we offer Current Tours Sample Tours What to do Travel Tips

Booking Form
Tour: *
Title: *
Full Name: *
  (As it appears on your passport)
Suffix:
Address 1: *
 
City: *
State: *
Postal Code: *
Country: *
Home E-Mail: *
Re-enter your E-Mail *
Work E-Mail:
Re-enter your E-Mail:
Home Phone:*
Work Phone:
Cell Phone:
   
Address 2:
 
City:
State:
Postal Code:
Country:
Home E-Mail:
Re-enter your E-Mail:
Work E-Mail:
Re-enter your E-Mail:
Home Phone:
Work Phone:
List each family member who has allergies with their corresponding medications.
Name:
Allergy
Medication
Name:
Allergy
Medication
Name:
Allergy
Medication
Name:
Allergy
Medication
List each family member with the medications they use.
Name:
Medication
Name:
Medication
Name:
Medication
Name:
Medication
List any physical limitations you or a family member have.
Name:
Limitation
Name:
Limitation
Name:
Limitation
Name:
Limitation
   
   
I have checked with my medical insurance provider and my provider does cover my/our medical needs while overseas.

I have read the description of this tour ,and I affirm that I have answered all questions on this form to the best of my ability. I also understand that the cost of the tour does not include the cost of the international airfare,or lunches, souvenirs, or any medical emergencies while a part of this Tour. Any travelling or sightseeing done apart from the Tour, will be my sole responsibility.

By my initials, I acknowledge this agreement.

 

 

 

 
© 2006 Covenanter Theological Institute Email us