Register - Global Academics

CONTACT INFORMATION

Email Address

PASSPORT INFORMATION

Name as it appears on your passport

Passport Passport Issuing Country

Passport Expiration Date

TRIP CHOICE

Trip Title

Trip Country

DIETARY RESTRICTIONS

Are you a vegetarian? Are you a vegetarian? Yes No

Do you have any dietary restrictions? Do you have any dietary restrictions? Yes No

If so, please describe:

ACCOMODATIONS

Have you selected a roommate? Have you selected a roommate? Yes No

If yes, roomate name:

Do you want a roommate selected for you? Do you want a roommate selected for you? Yes No

Single Room Occupancy Single Room Occupancy Yes No

*For Single Room Occupancy there is an additional fee.

EMERGENCY CONTACTS

Your Cell Phone Number on the Day of Departure

Emergency Contact 1

Emergency Contact 1 Email

Emergency contact 1 Phone

Emergency Contact 2

Emergency Contact 2 Email

Emergency contact 2 Phone

CANCELLATIONS/REFUNDS

Cancellations: Cancellation must be made in writing via email. The following charges and refunds will apply when cancellation is made after the registration is confirmed by Global Academics:

Deposits: All Deposits are non-refundable and not transferable. No exceptions can be made.

If a trip is cancelled more than 90 days prior to start date:Any cancellation fees, surcharges, or nonrefundable deposits charged to Global Academics by individual hotels, airlines or other third parties willbe charged to the client. The remainder of any payments paid to Global Academics will be refunded excluding the deposit.

If a trip is cancelled between 90 and 45 days prior to start date: Any cancellation fees, surcharges, or nonrefundable deposits charged to Global Academics by individual hotels, airlines or other third parties will be charged to the client. Additionally, a cancellation fee of 10% of the total trip cost will apply. The remainder of any payments paid to Global Academics will be refunded excluding the deposit.

If a trip is cancelled between 45 and 30 days prior to start date: Any cancellation fees, surcharges, or nonrefundable deposits charged to Global Academics by individual hotels, airlines or other third parties will be charged to the client. Additionally, a cancellation fee of 25% of the total trip cost will apply. The remainder of any deposits or payments paid to Global Academics will be refunded excluding the deposit.

If a trip is cancelled within 30 days prior to arrival date: 100% cancellation fees will apply. No refunds will be made.

General Refund Policy: Refunds will be made in accordance with the Cancellations and Refund Policy mentioned above. No additional refunds will be made for no-shows or any unused part of the itinerary whether voluntary, caused by airline delay or cancellation, or any other factor beyond the control of Global Academics including but not limited to acts of God (sickness, injury, poor health, weather, etc.) strike, detention, riot, war, quarantine, theft, civil disturbances, government regulations or restrictions, third-party or subcontractor negligence, or any other. No responsibility can be accepted for expenses incurred due to delay or change in schedule or other causes.

Deposit Acknowledgement:

Your Name

understand the above stated Refund Policy and agree to comply with the stated policy.

Signature:

Date (MMDDYYYY)

WAIVER AND RELEASE AGREEMENT FOR INTERNATIONAL TRAVEL

Your Name

, have agreed to participate in the Global Academics abroad program in (Destination)

Your Destination

from (date)

to (date)

in consideration for being permitted to participate in the Program, I hereby agree and represent that:

1. I have or will secure health insurance to provide adequate coverage for any injuries or illnesses that I may sustain or experience while participating in the Program. By my signature below, I certify that I have confirmed that my health care coverage will adequately cover me while outside the United States, and hereby release Global Academics and its employees and agents from any responsibility or liability for expenses incurred by me for injuries or illnesses, including death, that I may incur because of those injuries or illnesses.

2. I understand that, although Global Academics will attempt to maintain the Program as described in its publications and brochures, it reserves to the right to change the Program, including the itinerary, travel arrangements, or accommodations, at any time and for any reason, with or without notice, and that neither Global Academics nor its employees and agents shall be responsible or liable for any expenses or losses that I may sustain because of these changes.

3. I understand that Global Academics serves the right to decline to retain me in the Program at any time should my actions or general behavior be determined to impede or obstruct the progress of the Program in any way.

4. I understand that, although Global Academics has made every reasonable effort to assure my safety while participating in the Program, that there are unavoidable risks in travel overseas, and I hereby release and promise not to sue Global Academics, its employees and agents for any damages or injury, including death, caused by, deriving from, or associated with my participation in the Program, except for such damages or injury as may be caused by the gross negligence or willful misconduct of the employees or agents of Global Academics.

5. I agree that, should any provision or aspect of this agreement be found to be unenforceable, that all remaining provisions of the agreement will remain in full force and effect.

6. I represent that my agreement to the provisions herein is wholly voluntary, and further understand that, prior to signing this agreement; I have the right to consult with the adviser, counselor or attorney of my choice.

7. I agree that, should there be any dispute concerning my participation in the Program that would require adjudication in a court of law, such adjudication will occur in the courts of, and be determined by the laws of the state of California.

8. This agreement represents my complete understanding with Global Academics concerning the agency's responsibility and liability for my participation in the program, supersedes any previous or contemporaneous understandings I may have had with the agency on this subject, whether written or oral, and cannot be changed or amended in any way without my written concurrence.

9. I represent that I am at least eighteen years of age or, if not, that I have secured below the signature of my parent or guardian as well as my own.

Participant’s signature (please type your name in ALL CAPS to indicate your signature)

Participant's Name

Date

Parent or Legal Guardian’s signature (please type your name in ALL CAPS to indicate your signature)

Guardian Signature

Date

ASSUMPTION OF RISK FORM

I agree that as a participant in the Abroad Program at Global Academics I am responsible for my own behavior and well-being. I accept this condition of participation, and I acknowledge that I have been informed of the general nature of the risks involved in this activity, including, but not limited to organized events.

I understand that in the event of accident or injury, personal judgment may be required by the Program Leader or agency personnel regarding what actions should be taken on my behalf. Nevertheless, I acknowledge that the Agency and/or Program Leader may not legally owe me a duty to take any action on my behalf. I also understand that it is my responsibility to secure personal health insurance in advance, if desired, and to take into account my personal health and physical condition.

I further agree to abide by any and all specific requests by Global Academics and Program Leader for my safety or the safety of others, as well as any and all of the Agency and Program’s rules and policies applicable to all activities related to this program. I understand that the Global Academics reserves the right to exclude my participation in this program if my participation or behavior is deemed detrimental to the safety and welfare of others. In consideration for being permitted to participate in this program, and because I have agreed to assume the risks involved, I hereby agree that I am responsible for any resulting personal injury, damage to or loss of, my property which may occur as a result of my participation or arising out of my participation in this program, unless any such personal injury, damage to or loss of my property is directly due to the negligence of Global Academics and/or Program Leader. I understand that this Assumption of Risk form will remain in effect during any of my subsequent visits and program related activities, unless a specific revocation of this document is filed in writing with Global Academics at which time my visits to or participation in the program will cease. I acknowledge that I have read and fully understand this document. I further acknowledge that I am accepting these personal risks and conditions of my own free will.

I represent that I am 18 years of age or older and legally capable of entering into this agreement.

Participant’s signature (please type your name in ALL CAPS to indicate your signature):

Participant's Name

Date

If participant is less than 18 years of age, the following section must be completed:

My child/ward is under 18 years of age and I am hereby providing permission for him/her to participate in this program, and agree to be responsible for his/her behavior during this event.

Child's Name

Date

Parent or Legal Guardian’s signature (please type your name in ALL CAPS to indicate your signature)

Guardian Signature

Date

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