Rosemont Registration 2025

ROSEMONT SENIOR TRIP 2025 REGISTRATION FORM

Price Per Student $785.00
Student Name: *

First NameLast Name
Gender:*
Student Date of Birth:*

MonthDayYear
Date
Address of Student:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Students Email:*
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Phone:*
Please enter a valid phone number.
Parents Email:*

Acknowledgment of Terms and Conditions:*

I, the parent/guardian as listed of the above named student have reviewed the terms and conditions of this trip package. I agree to and accept the terms and conditions of this trip package. I agree to and accept the terms and conditions including the terms and conditions of the payment plan. By selecting the radio button, I acknowledge that this
Travel protection is offered for this trip, but must be selected within 5 days of purchase. The link to purchase travel protection is provided on the website near the registration link.

Insurance link: https://advisors.travelguard.com/buy?ta_arc=05743275&pc=PCTUSASLG&agencyemail=becky@crystalandcleartravel.com&ta_initials=Rebecca_Hypolite
Travel Insurance:*

I will purchase travel protection for this trip.I waive travel protection and understand that any costs ensued are the responsibility of the parent/guardian.
Does your student have physical, behavioral (mental/emotional), developmental or intellectual disabilities or health conditions that may affect participation in the senior trip? Your child is considered to have a disability if they have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. If yes, please specify. (If not, place N/A in box)*
Disabilities include but are not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism spectrum disorders, cerebral palsy, HIV/AIDS, schizophrenia, muscular dystrophy, bipolar disorder, major depressive disorders, multiple sclerosis (MS), missing or partial limbs, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), any impairment requiring the use of wheelchair, intellectual disabilities, migraine headaches, or any other condition that limits a major life activity.
Signature*

Clear

Credit Card Information

Monthly payments will be drawn on card on file. Should card need to be changed you will need to fill another form out.

Rosemont Senior Trip 2025

RHS Senior Trip DepositAfter receiving your deposit, we will contact you to finalize your monthly payment option. All deposits are non-refundable.

$50.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human
I hereby authorize Crystal & Clear Travel to charge my credit/debit card for monthly payments.
Credit Card Signature:*

Clear
Date:*

MonthDayYear
Date
PLEASE NOTE - Be sure to add accounts@crystalandcleartravel.com to your email account. This is the address that will correspond with your through out the year.
Should be Empty:

ROSEMONT SENIOR TRIP 2025 REGISTRATION FORM

Credit Card Information

I hereby authorize Crystal & Clear Travel to charge my credit/debit card for monthly payments.