Clone of Screening Form

1

Full Name

First Name

Last Name

2

Date of Birth

Date

3

Email Address

example@example.com

4

Phone Number

Please enter a valid phone number.

5

Have you traveled To Puerto Rico before?

Yes / No

6

Do you know anyone in Puerto Rico?

Yes / No

7

Are you able to hike up to 4 miles?

Yes / No

8

Prefer 1 bedroom | 1 Guest occupancy

Yes

No

Open

9

Prefer 1 bedroom | 2 Guest

Yes

No

Open

10

Prefer 1 shared unit with 4 bedrooms

Yes

No

Open

11

Do you have a REAL ID?

Yes / No

12

Valid and Current Drivers License?

Yes / No

13

Do you have a Valid Passport?

Yes / No

14

What would you like to get out of this trip?

15

Do you have any Heart Problems/Conditions?* This field is required.

Yes

No

Other

16

Please specify

17

Any type of allergies?* This field is required.

Yes

No

18

Please specify

19

Additional Comments