Online Enrollment Application

1. Student & Trip Info 2. Parent Info 3. Terms & Deposit 4. Review Details 5. Confirm & Print

Student & Trip Information

This is step 1 of 5. Please complete all steps to successfully submit your application. Fields marked with an * are required.

* Legal First Name
  Middle Name
* Last Name
Prefered name
* Birth Date / /
* Country of Citizenship
* Current Grade
* Gender Male Female
* Height
* Weight lbs
* T-Shirt Size Small Medium LargeExtra Large
* Scuba: Will you be certified or have a referral by summer? Yes No
  What scuba certs. will you have?
* Sailing: Do you have any experience? Yes No
  Tell us a little about your sailing experience.
* Student Email Address
* Student Cell Phone
* Do you take any prescription medications: Yes No
  Please tell us about the medications that you take.
* Do you have any dietery considerations, food or drug allergies or other medical considerations: Yes No
  Please describe.
* Do you have a history of asthma, sinus or ear problems? Yes No
  Please tell us about this history.
* At any point in the last 12 months have you (the enrolling participant) been under the care of a psychiatrist or psychologist? Yes No
The very nature of our programs creates a living, social and working dynamic that is very different to the home environment. For this reason, if the student has been under the care of a psychiatrist or psychologist at any point in the last 12 months we ask that the Counseling Professional complete a specific questionnaire that we have created. Exceptions to this requirement may be alumni who have previously submitted this form and been accepted into the program. We will provide you this form upon provisional acceptance into the program or, alternatively, call or email us so that we can send you a copy of the form in advance of application.

Name and Location of Student's School:
* How did you hear about us? (please be specific)

In order to complete your program selection, please refer to the ActionQuest trip Selection Chart found in the brochure or on the website. Alternatively click HERE for the program table. For extended trip combinations, please fill in both desired programs.


Program Selection 1
* Program Name & Dates:
  Should This Program Be Full, Please

Place me on the selected program waiting list
and/or reserve me a space on a secondary program

  Back-Up Program Selection
  Are You Applying For Two Programs With Us This Summer? No      Yes
Program Selection 2
  Second Program Name & Dates:


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