Tanzania February 2016

North Broward Preparatory School

7600 Lyons Road . Coconut Creek, FL . 954.247.0011
Global Campus Worldwide Tanzania Expedition

Trip Dates: February 9 - 18, 2016

Trip Cost: Approx. $2000 per Student

Final cost determined at time of airline booking plus an additional $325 for insurance and meals on travel days

Registration Deadline: Monday, October 12, 2015
Student Information

Please provide information exactly as it appears on student's passport
First Name *
Middle Name
Last Name *
Gender *
Birth Date *
Parent/Guardian Information
Parent First Name *
Parent Last Name *
Street Address *
Street Address Line 2
City *
State *
Zip Code *
Home Phone Number *
Cell Phone Number *
Today"s Date *

Month Day Year
Date
Parent Email *

Trip Enrollment Agreement
Payment/Authorization/Release Agreement I, parent/legal guardian of the above-named student (hereinafter “Student”), enter into this Agreement knowingly and willingly and hereby give my express permission and consent for the Student to participate in this program. I hereby release and hold Meritas, LLC and its affiliated companies and schools and their respective officers, employees, agents and representatives (hereinafter collectively referred as “Meritas”) harmless from any injury, loss, or damage to or by the Student. I agree to indemnify Meritas for all injury, loss or damage to the person or property of others caused by the Student. I release and hold Meritas harmless from any liability for reasonable decisions or actions as may be taken to protect the health and safety of the Student. In the event of an accident or emergency, I authorize Meritas to provide, or seek the provision of, health care services for the Student, at my expense, as deemed necessary, and I release and hold Meritas harmless from any and all liability resulting from such health care services. I further agree to assume full responsibility for the payment of all debts that may be incurred by the Student during his/her participation in this program.
I have read this Trip Enrollment Agreement and acknowledge its terms and conditions. I understand that all fees are non-refundable , regardless of reason or circumstance and that the School"s standards of conduct/Honor Code are in full force and effect during the entire trip. *

Yes, I accept the terms of this Agreement
Please Check One: *

Please bill my North Broward account. I understand that the trip fee must be paid in full prior to the departure of the trip. I will drop off a check at the Business Office by January 10, 2016 made payable to North Broward Preparatory School for the full amount of the trip.
Are you interested in finding out about Student Travel Insurance? *

Yes No
Student Travel Insurance

In the last several years, we have found that the demand for travel insurance for student trips has decreased. Due to this decrease in participation, we can no longer offer cost effective group travel insurance for our student trips. For those still interested in trip insurance, we would recommend purchasing an individual travel insurance policy for their student"s trip. Travel Guard and Travel Insured both offer individual Travel Insurance plans. Both companies are highly reputable companies in the industry. Families, however, are free to purchase a plan from anyone they choose. When purchasing a travel insurance policy, it is important that you understand it"s coverage completely. Most basic policies cover only medical, injury or death related cancellations and require documentation of the same. Cancellations due to financial, disciplinary, or scheduling conflicts are not usually covered. Families should also keep in mind that they are entering into the contract alone and that Meritas and its affiliated schools are without influence or control of the purchase plan or the outcome of any claims. It is further suggested that when purchasing insurance, that you keep track of the dates and amounts of all payments for the trip and be prepared to provide documentation of same. This information will be provided should you need to submit a claim. Here are links for two companies that we have used in the past. Travel Guard and Travel Insured

Authorization for Over-the-Counter Medication
I hereby give the Health Care Manager or his/her designee permission to apply or give one or more of the following over-the-counter medications or external preparations, in accordance with the directions for use on the container. Please check all that apply. *

Tylenol Ibuprofen Benadryl Antibiotic Ointment First Aid Spray Any other over-the-counter medications my child may need
Please let us know any special instructions regarding over-the-counter medication.
NOTE: Other than those mentioned above, All medications need to be in the original packaging, with specific instructions for administration. Please make sure your child's name is on each medication sent in. All medications must be supplied by parents and given directly to the designated chaperone/health care manager. In the event it is necessary to purchase specific medication while on the trip, your school account will be billed for the cost.
By checking the box below, I/we release Meritas LLC, the staff of Meritas Student Travel and all Meritas affiliated schools from any liability for administering these over-the-counter medications *

Yes, I agree to the terms above.

Notes
Please inform us of any other vital information you think the chaperone may need to know about your child, including any food allergies. Please do not use this form for specific travel arrangements.
By submitting this form and signing below I agree that all information contained herein is true and agree to all the terms of this Agreement.
Parent Signature *

Clear
Parent Signature (Please Type) *
Student Signature *

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Student Signature (Please Type) *
Should be Empty:

North Broward Preparatory School

Global Campus Worldwide Tanzania Expedition

Trip Dates: February 9 - 18, 2016

Trip Cost: Approx. $2000 per Student