Summer Expedition Registration Form

Summer Expedition Registration

Please fill out the form carefully
Youth's Name/Name of Participant (Nombre del Participante) *

Last Name (Ultimo Nombre) First Name (Primer Nombre)
Birth Date (Fecha de Nacimiento) *

Month Day Year
Gender (Género) *
Entering Grade *
Phone Number (Número de Teléfono)
Please enter a valid phone number. (Por Favor Ingrese un Número de Teléfono Válido)
Parent/Guardian Name (Nombre del Padre/Guardián) *

Last Name (Ultimo Nombre) First Name (Primer Nombre)
Phone Number (Número de Teléfono) *
Please enter a valid phone number. (Por Favor Ingrese un Número de Teléfono Válido)
Email *
example@example.com
Address (Dirección) *

Street Address (dirección de casa)

Street Address Line 2

City (Ciudad) State / Province (Estado/Provincia)

Postal / Zip Code (Código Postal)
Name of Insurance Provider (Nombre del Proveedor de Seguros)
Policy Number (Número de póliza)
Primary Care Physician (Médico de Atención Primaria)
Address and Contact Information (Dirección y Información del Contacto)
Hospital of Choice (Hospital de Elección)
List Any Medication Allergies (Lista de Alergias a Medicamentos)
Any Known Allergies (Alergias conocidas)
List Any Dietary Restrictions (Restricciones Dietarias)
List Any Medical Conditions we need to be Aware of and Treatment (Enumere las Afecciones Médicas que Debemos Conocer y el Tratamiento)
Emergency Contact (Contacto de Emergencia) *

Last Name (Ultimo Nombre) First Name (Primer Nombre)
Emergency Contact Phone Number (Número de Teléfono) *
Please enter a valid phone number. (Por Favor Ingrese un Número de Teléfono Válido)
Additional Demographic Information (select all that apply) (Información Demográfica Adicional) *

Native Indian or Alaska Native/Nativo India o Nativo de Alaska Asian/Asiático Black or African American/Negro o Afroamericano Native Hawaiian or Pacific Islander/Nativo Hawaiano o Isleño del Pacifico Latino/Hispana White/Blanco Other/Otro
*Optional* Does your Youth Qualify for Free or Reduced Lunch? (*Opcional* ¿Su Joven Califica para Almuerzo Gratis o Reducido?)

Yes/Si No
*Optional* Primary Language Spoken at Home (*Opcional* Idioma Principal Hablado en Casa)
Additional Comments (Commentos Addicionales)
Does your child qualify for Free/Reduced Lunch? (If yes, please upload proof below)

Yes, my student qualifies for Free/Reduced Lunch
Proof/Documentation of Qualifying for Free/Reduced Lunch

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How did you learn about New Treks? *
Please select your expedition of choice below.

Note: You may select both if your student is interesting in going on both trips. You will be sent a confirmation email with payment options after submitting.
Expedition Options *
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Colorado National Park Trip: Great Sand Dunes & Rocky Mountain June 20 - 24 Grades 9-12Adventure to the Great Sand Dunes before exploring the stunning landscape of the Rocky Mountain National Park *reduced cost of $850 for Free/Reduced Lunch
$ 1,350.00 Entering Grade Do you qualify for Free/Reduced Lunch?

Colorado National Park Trip: Mesa Verde & Black Canyon of the Gunnison July 18-22Grades 9-12 Immerse yourself in the ancient architecture of Mesa Verde before heading to the awe-inspiring depths of the Black Canyon. *reduced cost of $850 for Free/Reduced Lunch
$ 1,350.00 Entering Grade Do you qualify for Free/Reduced Lunch?

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Summer Expedition Registration

Please select your expedition of choice below.