new directions registration form

About the Traveler

Please note: If a traveler must be sent home early due to disruptive or aggressive behavior, or is refused boarding by an airline or cruise ship due to lack of valid identification, this will occur at the traveler's expense and without refund. Please consider this carefully before signing up for a tour. Thank you.
What is this registration to be used for?


We need their legal name that is on their photo I.D.


example: Billy, Buddy, Susie, etc.
Use a slash or a dash between month/day/year and enter the year as four digits, example: 10/10/1960










COGNITIVE / MENTAL INFORMATION



DIABETES INFORMATION
SEIZURE INFORMATION
SELECT ALL THAT APPLY
MOBILITY INFORMATION







Traveler's Behavior

If a traveler must be sent home early due to disruptive or aggressive behavior, this will occur at the traveler's expense and without refund. Please consider this carefully before signing up for a tour.


Traveler's Self Care

Dressing

Bathing

Feeding

Traveler's Self Care

Hygiene

Toileting




Swimming Ability Is the traveler okay to use a hot tub?
Safety Skills
Money Skills
Sleeping Habits


Traveler's Address








leave blank if you do not have one
Traveler Billing Contact








Additional Traveler Contact Roles

Billing Contact - Who do we send invoices, statements, etc? Travel Day Contact - Who do we contact on the first and last day of the tour for travel related issues? Mailing Contact - Who do we send the traveler's itinerary, packing list, name badge, etc?
Who will be the contact person on the first and last day of the tour for travel related issues?
Travel Day Contact









Who would you like to receive the traveler's itinerary, flight info, packing list, name badge, etc?
Tour Information Mailing Contact










Tour Payment





Contact Information