Pre-Trip Information

"*" indicates required fields

Name*

First Last

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Discipline/Credentials*

What areas of your field do you have experience in/have you had placements in?*

Do you have any specialty areas or special interests in the field?*

What do you hope to learn or do during the trip?*

Do you have any questions that we can answer during orientation?

Please select your t-shirt size:*

Please note that t-shirt distribution is based on our current inventory and you may not receive your exact size.

Excursion Questions

During the trip you will be participating in a variety of excursions with the rest of the group. These may include activities such as walking up to 2 miles, floating a river, ziplining, riding a boat, being in close proximity to/holding animals, climbing a large amount of stairs, and more. The following questions will help us plan and prepare for you to participate in the excursions.

Do you have any fears of heights, animals, water, etc.?*

Do you anticipate having difficulty with any of the physical requirements of the activities listed above? (walking, hiking, etc.)*

Emergency Contact Information

Emergency Contact Name*

First Last

Relationship*

Emergency Contact Phone Number*

Emergency Contact Email*

Voluntary Medical and Disability Information

The purpose of this gathering this information is to give Therapy Adventures International and/or its partners and agents (as applicable) information necessary to help you before and during your international experience. The information provided will remain confidential among relevant parties. It is not used to make admission decisions. Please contact Therapy Adventures International if you wish to discuss any concerns.

Do you have any medical conditions or disabilities that you wish to disclose?*

Do you anticipate needing any accommodation(s) during the trip?*

Please list any dietary restrictions or allergies*

Trip Documents

Passport*

Max. file size: 50 MB.

Proof of Health Insurance*