Cruise INTAKE FORM

Cruise Intake Form

Take a vacation while helping without additional cash out
Full Name*

First NameLast Name
Mailing Address:*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
E-mail :*
ex: myname@example.com
Phone:*
Cruise Preference:*
Sail date, cruise line, promotion
Best time to contact you:*
ex: via email or phone call in the morning
Additional Questions:
If you have additional questions about cruises
Processing your Cruise
Please upload your Passport here

Browse Files

Cancelof
Please upload your Driver's License

Browse Files

Cancelof
Agreement
Please check the following boxes to indicate your understanding and agreement:*

I agree to have my information shared for travel purposes
E-Signature
By signing (typing your legal name) in the space below, you agree to the collection, use and processing of the personal information you provide in this form for the purposes of organization administration and inclusion of your contact information in a members’ directory that will be distributed to members and staff and key partners.

By signing, you are also certifying that all information is correct and that you are the person completing this application. You also agree that your information may be accessed and used by House of Helping Hands and its staff. You agree to notify House of Helping Hands' Staff of any change to your personal information and make requests to check, delete or correct your personal information, so that it is accurate and current. You understand that the majority of the data requested in this application is necessary for administrative and planning purposes and that the failure to provide this information may prevent your application from being properly processed or the inclusion of your contact information in the members directory.
E-Signature:*
Should be Empty:

Cruise Intake Form

Processing your Cruise

Agreement

E-Signature