Maui 2026

1
Student Legal Name* This field is required.
First Name
Last Name
2
Student Birth Date* This field is required.
Month
Day
Year
3
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Emergency Contact* This field is required.
First Name
Last Name
5
Emergency Contact Phone Number* This field is required.
6
Emergency Contact Email* This field is required.
example@example.com
7
Any allergies? Check all that apply* This field is required.
Food
Medication
Environmental
Other
I have no allergies
8
Please list and explain any allergies* This field is required.If none type "N/A"
9
Significant Medical History (surgery, injuries, serious illness):* This field is required.If none type N/A
10
List Any Medical Conditions (asthma, seizures, headaches, recent injuries):* This field is required.If none type N/A
11
Is any medication required?* This field is required.
Yes
No
12
List any medication taken regularly:* This field is required.If none type "N/A"
13
If medication is necessary please provide administration instructions:* This field is required.If none type "N/A"
14
Specify any reactions or symptoms to medication:* This field is required.If not applicable type "N/A"
15
Additional medical information POST needs to know in regards to your childs health (physical or mental).* This field is required.If not applicable type N/A
16
Name of Medical Insurance Company:* This field is required.
17
Insurance Policy Number:* This field is required.
18
Insurance Expiry Date:* This field is required.
Month
Day
Year
19
Primary Care Physician's Name:* This field is required.
20
Physician's Phone Number* This field is required.
21
CONSENT AND LIABILITY
22
I have read and agree to all terms & conditions listed below.* This field is required.As a parent or legal guardian of the previously-named participant, or for myself if I am over 18, I give permission for my child to attend and participate in the activities sponsored by Mac's Field Trips. (If signing for myself as a legal adult, “child” in this document refers to me.) I acknowledge that this activity entails known and unanticipated risks that could result in physical or emotional injury, paralysis, or death to my child, as well as damage to property, or to third parties. I understand that such risks cannot be eliminated without jeopardizing the essential qualities of the activity. I assume the risk and financial responsibility for any injury, illness, or liability resulting from my child’s participation. I waive any claims against and agree to hold harmless and not sue, Mac's Field Trips, Mac's Field Trips staff, Mac's Field Trips Executive Committee, Mac's Field Trips chaperones, related parties, or other organizations associated with sponsoring the activity from any and all claims or liability arising out of my child’s participation. I have been made aware of the trip itinerary and give permission for my child or ward to ride in any vehicle designated by the staff of Mac's Field Trips while attending or participating in activities sponsored by Mac's Field Trips. I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of my child while participating in activities sponsored by Mac's Field Trips, to be used, distributed, or shown as Mac's Field Trips sees fit. I certify that my child has no medical or physical conditions that could interfere with his/her safety in this activity, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition. In case of an emergency involving my child, I understand every effort will be made to contact me (or emergency contact provided). In the event I cannot be reached, I authorize a qualified physician/surgeon selected by the adult leader in charge to examine and in the event of injury or serious illness administer emergency care to the above named-participant which may include hospitalization, anesthesia, surgery, or injections of medication for my child. I understand every reasonable effort will be made to contact me to explain the nature of the incident prior to any involved treatment. In the event it becomes necessary for Mac's Field Trips chaperones, EC, or staff to obtain emergency care for my student, I agree that neither Mac's Field Trips nor any of its personnel assumes financial liability for expenses incurred because of the accident, injury, or illness.
I agree
23
Print Name of Participant* This field is required.
24
Signature of Participant* This field is required.
Clear
25
Date of Signature* This field is required.
Date
Year
Month
Day
26
Print Name of Parent/Guardian* This field is required.If over 18 and signing for yourself as a legal adult, you can write N/A
27
Signature of Parent/Guardian* This field is required.If over 18 and signing for yourself as a legal adult, you can write N/A
Clear
28
Date of Signature
Date
Year
Month
Day
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