Central Europe Tour Information Form
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Email *
Student Last Name  *
Student First Name  *
Personal Email (non mbusdapps account) *
Primary Orchestra Instrument *
Current Grade Level *
MCHS Orchestra Group (check one group only) *
Student Legal Last Name (as it appears on their passport) *
Student Legal First & Middle Name (as it appears on their passport) *
Passport Country of Citizenship *
Passport Number *
Passport Date of Issue *
MM/DD/YYYY
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DD
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YYYY
Passport Date of Expiration *
MM/DD/YYYY
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DD
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YYYY
Student Cell Phone Number *
Date of Birth *
MM
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DD
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YYYY
Will the student have international call access during the trip? *
Will the student be able to receive group text messages on their cell phone during the trip (will have international cell coverage plan for travel within Czechia and Poland)? *
Will the student be able to receive group text messages on wifi-based apps (e.g. Whatsapp, Groupme)? *
List any food allergies (write N/A if you have none). *
List any other dietary restrictions (write N/A if you have none). *
List any medication allergies or other non-food allergies (write N/A if you have none). *
List any prescription medications (write N/A if you have none). *
Does the student have permission to carry their own medicine? *
List any medical equipment required for flight/ground transportation, if any (write N/A if you have none). *
Medical Insurance Provider Name *
Medical Insurance Policy Number *
Primary Physician Full Name *
Primary Physician Phone Number *
Primary Physician Address *
Father's Full Name *
Father's Email *
Father's Cell Number *
Mother's Full Name *
Mother's Email *
Mother's Cell Number *
Name of Emergency Contact (other than parents) *
Relationship of Emergency Contact *
Emergency Contact Email *
Emergency Contact Cell Number *
Student T-shirt Size (men sizes) *
Will student be returning with the orchestra group on 7/2/23 on one of our pre-reserved flights? *
List up to 5 students you wish to request in your chaperone group (for info collection only; no guarantees). *
Has the student been certified in first aid training within the past two years? *
Has the student been certified as a life guard within the past three years? *
List any other important information that our tour staff and adult chaperones should know about you.
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