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Summer Credits Application Form

Step 1 - General Information

 * mandatory fields
First Program Choice*   Second Program Choice*
 
First Course Choice*
 
Second Course Choice*
 
How did you hear about us?*  

Please note: If your first tour choice is not available, you will have the option
of participating on the second tour or having a full refund and not traveling.
 
 

Student Information
Title*   First Name*
(as it appears in passport) 		 
Gender*   Middle Name or Initial
(as it appears in passport)
Birthdate*
   
 
Last Name*
(as it appears in passport) 		 
  IMPORTANT: Airlines will not allow you to travel if the name entered above, does not match the name on your passport EXACTLY. Please ensure that this information is correct or you will be charged a significant name change fee.
Address Line #1*   Province/State*  
Address Line #2 Country*  
City*   Postal/Zip Code*  
 
Home Phone #*   Student Email*  
Mobile Phone #
(Parent/Guardian only)		 Confirm Student Email*    
Allergies
Special Requests
(egs. Rooming/Dietary)
Health Concerns
(egs. Mobility Issues, Asthma, Mental Health Issues)
* It is your responsibility to inform Georgia Hardy Tours of any medical conditions that may affect you while on the tour.
Dietary


* All meal requests are final at time of registration.
* Please note we are not able to accommodate Halal, Kosher or any other dietary requests (not including allergies).
 

Academic Information
Home School*   OEN number
(Note: Your OEN number is different than your student number. You will find this on any of your past transcripts or if you call/ask your guidance department they will have this information)

Parent/Guardian Information
Full Name*  
Address Line #1*   Province/State*  
Address Line #2 Country*  
City*   Postal/Zip Code*  
Home Phone*   Business Phone
Mobile Phone Parent Email*  
    Confirm Parent Email*    

Passport Information
** Please be advised that your passport must be valid for at least 6 months after your return date.
Full Name on Passport*
IMPORTANT: If this is not the way your name is shown in your passport please go back to the "Student Information" section and correct it.
Nationality*   Passport Number*  
Expiry Date*
   
 
Country of Issue*  
 

Emergency Contact Information
Full Name (main contact)*   Relationship*  
Home Phone*   Business Phone
Mobile Phone Contact Email
  Confirm Contact Email  

Insurance Information