Donnelly College Journey to Mexico City May 2024

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* 1. You must have a passport that does not expire before 1 Dec 2024. In order for your registration to be complete, you need to send a scan or closeup digital photo of your passport (open to the page with your photo and personal data, with all information legible) to MMaher@SaintChristopherJourneys.com. If you do not have a passport, you need to send a scan of your passport application. This is used to purchase your air ticket, which must match your passport exactly. If you have a non-US passport, you also need to send a scan or closeup digital photo of your green card or US visa.

Yes, I have emailed a copy of my passport (and other needed items) to MMaher@SaintChristopherJourneys.com

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* 2. In order for your registration to be complete, you need to send a closeup digital photo of yourself (that really looks like you) to MMaher@SaintChristopherJourneys.com. This is only used for the student ID that will be issued to you by LaSalle University in Mexico and in case of an emergency. Please do not worry about having a "great picture." Just a recent, accurate photo is fine (a selphie snapshot from a phone for example). A blank wall background is best.

Yes, I have emailed a photo of myself to MMaher@SaintChristopherJourneys.com

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* 3. Please carefully read the "Waiver and Release" available on the "forms" page at SaintChristopherJourneys.com. Do you agree with the waiver and release? https://saintchristopherjourneys.com/forms.html

Yes, I have read the Waiver and Release, and I agree to it.

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* 4. Please carefully read the "Code of Conduct" available on the "forms" page at SaintChristopherJourneys.com. Do you agree with the Code of Conduct?https://saintchristopherjourneys.com/forms.html

Yes, I have read the Code of Conduct, and I agree to it.

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* 5. Please carefully read the "Crisis Management Plan" available on the "forms" page at SaintChristopherJourneys.com. https://saintchristopherjourneys.com/forms.html

Yes, I have read the Crisis Management Plan.

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* 6. I understand that all payments are non-refundable and non-transferable. I also understand that the final fee for the journey may increase due to unexpected increases in airfare, housing, other travel services, and changes in currency exchange rates. If not enough participants have been recruited for the journey by the initial deadline and the journey is canceled, I will be reimbursed my payments.

Yes, I understand conditions, and I agree to pay fees according to the schedule in the journey brochure.

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* 7. First Name:

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* 8. Last Name:

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* 9. Date of Birth

(Month/Day/Year MM/DD/YYYY)

Date

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* 10. Email address you use most often:

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* 11. Your Cell Phone Number

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* 12. Your mailing address, including zip code:

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* 13. Your Gender (this is used for housing assignments)

Male

Female

Other (please specify)

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* 14. Who would you like to room with (this information is kept confidential)

First Choice

Second Choice

Third choice

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* 15. The name of your health insurance company (If you do not have health insurance, just write “none.” Travel insurance may provide some limited health coverage.)

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* 16. Phone number of your health insurance company (If you do not have health insurance, just write "N/A")

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* 17. Your health insurance policy number (If you do not have health insurance, just write "N/A")

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* 18. Your health insurance group number, if applicable:

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* 19. Name of the primary insured person on your health insurance (if you do not have health insurance, just write "N/A")

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* 20. We are collecting medical information from you. It is completely optional for you to share this information. If you have a serious medical condition, we encourage you to wear jewelry that indicates your condition and needs. We compile this information and provide it to your group leader, your host organization (usually a university or church) and with LaSalle Univeristy in Mexico. While we handle your information carefully, our handling does not meet HIPAA standards for confidentiality. Again, this is optional. Do you have any medical conditions that would be important to know in case of an emergency, and that you would like to share with us?

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* 21. We are collecting medical information from you. It is completely optional for you to share this information. If you have a serious medical condition, we encourage you to wear jewelry that indicates your condition and needs. We compile this information and provide it to your group leader, your host organization (usually a university or church) and with LaSalle University in Mexico. While we handle your information carefully, our handling does not meet HIPAA standards for confidentiality. Again, this is optional. If you would like, please share a list of medications you anticipate that you will be taking while on your journey.

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* 22. Do you have any special dietary needs?

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* 23. Do you have any special needs that would be helpful to know in planning your travel?

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* 24. Name of a person not traveling with you who we should contact in case of an emergency:

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* 25. Email address of the person to contact in case of an emergency:

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* 26. Phone number of the person to contact in case of an emergency:

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* 27. If you would like to provide a second emergency contact (of a person not traveling with you), please provide their name, email address, and phone number.

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* 28. As part of your signing and consent, please provide today's date

Month/Day/Year (MM/DD/YYYY)

Date

Donnelly College Journey to Mexico City May 2024

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* 3. Please carefully read the "Waiver and Release" available on the "forms" page at SaintChristopherJourneys.com. Do you agree with the waiver and release? https://saintchristopherjourneys.com/forms.html

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* 4. Please carefully read the "Code of Conduct" available on the "forms" page at SaintChristopherJourneys.com. Do you agree with the Code of Conduct?https://saintchristopherjourneys.com/forms.html

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* 5. Please carefully read the "Crisis Management Plan" available on the "forms" page at SaintChristopherJourneys.com. https://saintchristopherjourneys.com/forms.html

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* 7. First Name:

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* 8. Last Name:

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* 9. Date of Birth

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* 10. Email address you use most often:

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* 11. Your Cell Phone Number

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* 12. Your mailing address, including zip code:

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* 13. Your Gender (this is used for housing assignments)

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* 14. Who would you like to room with (this information is kept confidential)

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* 15. The name of your health insurance company (If you do not have health insurance, just write “none.” Travel insurance may provide some limited health coverage.)

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* 16. Phone number of your health insurance company (If you do not have health insurance, just write "N/A")

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* 17. Your health insurance policy number (If you do not have health insurance, just write "N/A")

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* 18. Your health insurance group number, if applicable:

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* 19. Name of the primary insured person on your health insurance (if you do not have health insurance, just write "N/A")

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* 22. Do you have any special dietary needs?

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* 23. Do you have any special needs that would be helpful to know in planning your travel?

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* 24. Name of a person not traveling with you who we should contact in case of an emergency:

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* 25. Email address of the person to contact in case of an emergency:

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* 26. Phone number of the person to contact in case of an emergency:

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* 27. If you would like to provide a second emergency contact (of a person not traveling with you), please provide their name, email address, and phone number.

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* 28. As part of your signing and consent, please provide today's date

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* 29. Signature: Please type out your full name as a form of electronic signature: