| TravelEd Registration Form |
Student Name_______________________________ Parent Name (if different)____________________ School_______ Home Phone___________________________ Cell Phone_______________________ Address________________________________ City_______________________ Zip_____________ M/F_____ Date of Birth _________ Grade_____ Social Studies Teacher____________________ Medical Insurance Carrier____________________________ Policy #_____________________________ Indicate which deposit plan you wish to use. Make check or money order (sorry no credit cards accepted) payable to TravelEd Please mail (do not bring to school) with completed Registration Form signed by parent and student to: TravelEd - P.O. Box 521 - Agoura Hills, CA. 91376 (CHECKS RETURNED FOR ANY REASON ARE SUBJECT TO A $25 FEE AND CANCELLATION OF RESERVATION) _ SPACE DEPOSIT ($275)_______ GUARANTEED PRICE OPTION ($500)______ MEDICAL INFORMATION Please list any and all prescription drugs taken by the above named student. For liability reasons, chaperones may NOT dispense medication or perform medical procedures. Please attach additional pages as needed. DRUG PRESCRIPTION# DOCTOR CONDITION BEING TREATED __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Please list any non-prescription drugs (OTC) that you DO NOT wish your child to have: Please list any allergies or other medical conditions the chaperones should be aware of such as asthma, epilepsy, diabetes, etc. This information helps ensure your child's safety: I have read and agree to the terms and conditions set forth on this and all other pages of this website. I hereby authorize TravelEd, chaperones and/or any other agents working with or for TravelEd to arrange such emergency medical services as may be required by trip exigencies. I voluntarily release, discharge, waive, and relinquish TravelEd, its officers, owners, chaperons, and agents from any and all liability or claims including but not limited to claims for bodily injury, emotional distress, property damage/loss, or wrongful death arising from actions other than willful and gross negligence. I attest that any and all pre-existing medical and/or psychiatric conditions have been noted above. I understand this is NOT a school sponsored activity. Furthermore, I understand that the above named student must abide by all disciplinary rules as set forth in the information provided on this website as well as verbal directions or rules provided at pre-trip meetings and those given by chaperons while on the trip. Failure to do so may result in the above named student being sent home early from the trip with all additional costs for such action becoming our sole responsibility and with NO refund of any monies paid. __________________________________________ _________________________________________________ SIGNATURE OF STUDENT DATE SIGNATURE OF PARENT/GUARDIAN DATE |
| Upon cancellation of the transportation or travel services, where the passenger is not at fault and has not cancelled in violation of any terms and conditions previously clearly and conspicuously disclosed and agreed to by the passenger, all sums paid to the seller of travel for services not provided will be promptly paid to the passenger, unless the passenger advises the seller of travel in writing, after cancellation. This provision does not apply where the seller of travel has remitted the payment ot another registered wholsesale seller of travel or a carrier, without obtaining a refund, and where the wholesaler or provider defaults in providing the agreed-upon transportation or service. In this situation, the seller of travel must provide the passenger with a written statement accompanied by bank records establishing the disbursement of the payment and if disbursed to a wholesale seller of travel, proof of current registration of that wholesaler. TravelEd is not a participant in the California Travel Consumer Restitution Fund. Deposit monies received are held in the TravelEd trust account at Ventura County Business Bank (#027002096) Our groups will utilize scheduled airline flights. The exact time of departure, type of aircraft and other pertinent flight information will be provided with the final billing in the Spring. |