1. Passport and Insurance Info

 
17% of survey complete.

Your Passport and Care Card 'numbers'. Please make sure to enter them carefully. This information is confidential and will NOT be shared with the exchange school.
I will also need a copy of your passport and care card for our files. This can be a scan or photo you e-mail or a photocopy I can scan.

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1. First Name as it appears in your Passport

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2. Do you use a different 'preferred' name

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3. Middle Names AS LISTED IN PASSPORT

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4. Family Name AS LISTED IN PASSPORT

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5. Your Birth Date

Date

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6. Place of Birth

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7. Nationality

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8. Gender

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9. Passport Issued at: (Location)

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10. Expiry Date of passport

Date

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11. Your Passport Number

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12. Your student number

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13. Your Grade NOW

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14. Your BC Medical (care card) number:

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15. Date of your last Tetanus Shot (should be less than 10 years ago, and most students had a booster in Grade 9?)

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16. Do you have any allergies or medical/physical conditions we need to be aware of?

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