2020 Hawaii Trip Registration

    - All fields are required.

    What trip would you like to participate in?

    Personal Information

    First Name:
    Last Name:
    Nickname:
    Gender:FemaleMale
    Date of Birth:

    Passport Number:
    Your Home Country:
    Your Email Address:
    Your Cell Phone Number:
    Exchange Year:

    Host Family Information

    Host Parent 1:
    Host Parent 2:
    Address:
    City:
    State:
    Zip Code:
    Phone Number 1:
    Phone Number 2:
    Email Address 1:
    Email Address 2:

    Information From Country Of Origin

    Home Address:
    City:
    State/Province:
    Country:
    Zip:
    Phone Number:
    Cell Phone:
    Email:
    Mother's Name:
    Father's Name:

    Medical Information

    Insurance Provider:
    Policy Number:
    Do you have allergies?YesNo
    If yes, allergic to what?
    Do you take medications?YesNo
    If yes, which medications?

    Do you have dietary restrictions?YesNo
    If yes, what are they?

    Do you know how to swim?YesNo

    Have you had swimming lessons?YesNo

    Your T-shirt size:

    Roommate Preference:

    Terms & Conditions

    View PDF. REQUIRED: *Please read and confirm your agreement with our Terms & Conditions:

    I agree