Perspectives Trip Registration

This is where we will get your final information for the trip! Completion of this form reserves your spot and serves as acceptance of your participation on a Perspectives Trip!

Confirmation of Passport Information
This is required for international travel.
Full Legal Name*
As written on your passport (for confirmation)
First Middle Last
Sex*
As written on your passport (for confirmation)
Date of Birth*
MM slash DD slash YYYY
Passport Number*
If you are currently not in possession of a valid passport expiring on or after November 22, 2023, OR if your passport's identification contains letters with numbers, please put a zero ("0") here and email [email protected]
Passport Expiration Date*
MM slash DD slash YYYY
Issuer of Passport*
Please list any Middle-Eastern, African, or Asian countries that have stamps in your passport.*
Photo of Passport
(Optional though encouraged)
Max. file size: 100 MB.
Personal Information
Preferred Name*
For nametag
Gender*
For roommate accommodations
Pronouns*
Dietary Accommodations
Please check all that apply.
- Vegetarian
- Vegan
- Kosher
- Gluten Free
- Peanut Allergy
- Tree Nut Allergy
- Dairy Allergy
- Other (please include at the bottom)
Zip Code of Residence*
ZIP / Postal Code
Please describe any religious observances that we should be aware of during this trip.
Please list any preexisting medical conditions that we should be aware of during this trip.
Please include all allergies, medications, and relevant medical conditions that may affect your ability to travel for long distances, hike (moderately), walk long distances, stick to a tight schedule, and be focused and engaged in our programming for very long days.
Anything else you wish to share?
COVID-19 Vaccination Information
Are you currently considered fully-vaccinated?*
- Yes
Photo of Current Vaccination Documentation*
Max. file size: 100 MB.
Medical Insurance Information
Our program includes limited local medical insurance that covers treatment and medication for conditions that occur during the trip and within Israel only. The policy does not cover pre-existing conditions. To ensure you are fully insured, please include your medical insurance information below. Details on the provided local medical insurance can be found at: https://www.authenticisrael.com/student-leadership-mission/prepare-for-your-trip/
Insurance Provider*
Insurance Policy Member ID*
Photo of Front of Insurance Card
(Optional though encouraged)
Max. file size: 100 MB.
Photo of Back of Insurance Card
(Optional though encouraged)
Max. file size: 100 MB.
Emergency Contact Information
Emergency Contact*
First Last
Relationship to Participant*
Emergency Contact Phone Number*
Emergency Contact Email*

Confirmation of Passport Information

Personal Information

COVID-19 Vaccination Information

Medical Insurance Information

Emergency Contact Information