2023 Ireland Traveler Information Form
Ireland: Literature, History, and Culture | July 13–24, 2023
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PASSPORT INFORMATION
Enter your name exactly as it appears on your passport. If you have no middle name listed on your passport, please enter a period. If you have more than one middle name, enter them both in the middle name field.
First name as it appears on your passport *
Middle name as it appears on your passport *
Last name as it appears on your passport *
Passport number *
Nationality (country that issued the passport) *
Date of birth *
MM
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DD
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U.S. State of birth
Do not abbreviate, do not include the city. If born outside the U.S., list the country.
 *
Passport date of issue
Note that your passport lists the day first, but this form wants you to enter the date as MONTH first.
 *
MM
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DD
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YYYY
Passport date of expiration
Typically passports expire 10 years minus 1 day after issue. For example: issued on 31 Oct 2021, expires on 30 Oct 2031. Please double-check the dates you've entered. And again, this form wants the month first.
 *
MM
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DD
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YYYY
Authority
On U.S. passports, Authority is listed to the right of Date of Issue. It's often United States Department of State, but not always.
 *
Preferred first name on name tag
 *
Will you be celebrating any special occasions during the trip?
 *
EMERGENCY CONTACT INFORMATION
Whom should we contact in case of emergency during the program? This should be someone not traveling with you. Please enter at least one phone number for your emergency contact.
Full name
 *
Relationship to you
 *
Best phone number
 *
Additional phone number
Email address
The information you provide next is meant to better equip the trip leader or host to effectively respond should a complication arise during the trip. This information will be held in strictest confidence by St. Olaf College staff.
PRIMARY PHYSICIAN
Name *
Phone number *
MEDICATIONS
We recommend you bring an extended supply of all medications, in their original bottles, including any over-the-counter remedies you use regularly, with you.
I take the following medications, about which I choose to inform St. Olaf College: *
HEALTH CONDITIONS, IMPAIRMENTS, OR RESTRICTIONS
I have the following HEALTH CONDITIONS about which I choose to inform St. Olaf College. (Examples include allergies, injuries, depression, anxiety, diabetes, emphysema, heart condition, seizures, recent surgery, or any other physical, mental or behavioral condition that would be important to know about in case of an emergency.) *
I have the following IMPAIRMENTS or RESTRICTIONS about which I choose to inform St. Olaf College. (Examples include impaired mobility, hearing, or vision that -- when not using corrective devices such as glasses or hearing aids -- may prevent you from participating fully in all trip activities as described in the trip description or itinerary, or that require special arrangements, equipment or assistance for you to participate in the program.) *
Further, I use or transport the following ASSISTANCE ITEMS on a regular basis. (Check all that apply.) *
Required
PARTICIPANT REQUIREMENTS

Alumni & Family Travel programs vary in pace, but in general, they require you, the participant, to be capable, without assistance, of walking a minimum of five miles per day, standing for 2 to 3 hours at a time, of climbing stairs that may not have handrails, of climbing in and out of a variety of transportation vehicles, of keeping pace with an active group of travelers on long days of traveling, of dealing with the emotional highs and lows that can occur when experiencing a different culture, and of being capable of traveling with a group for several hours each day. St. Olaf has published specific requirements for each Alumni & Family Travel Program. You are responsible for reviewing the specific requirements for your program and judging the appropriateness of these travel activities to your physical, mental and behavioral capabilities. Any participant who is unable to fulfill the program requirements may have their registration cancelled. Any participant who has demonstrated an inability, in the opinion of the program leader, of keeping up with the group or of safely participating in program activities may be prohibited from participating in certain activities.

When it is possible to do so, St. Olaf strives to make reasonable efforts to accommodate disabilities and other special needs of program participants if we are notified at the time of registration. If you have a special need regarding your participation in the program or will need an accommodation, you should contact the Alumni & Family Travel Director as soon as possible. Unfortunately, St. Olaf may not be able to accommodate all special needs. Facilities, resources, accommodations and protections for disabled and special needs individuals can be sharply limited outside the U.S. St. Olaf reserves the right to refuse to make an accommodation when not required to do so by law.

You are expected to behave in a reasonable manner toward other travelers, tour leaders, staff and other persons with whom you come into contact during the program. If you behave, in the opinion of the program leader, in a way likely to disrupt the enjoyment or endanger the safety of other travelers, you will be expelled from the group and will have to make your own arrangements to return home. No refunds for the unused portion of the program will be given. 

I acknowledge that I can meet these participant requirements. (If you mark no, the Travel director will be in touch to discuss your situation.)
 *
DIETARY INFORMATION
We can accommodate most dietary needs, as listed in the checkboxes below. Special dietary preferences such as low salt or "I only drink Diet Coke" cannot be guaranteed, but will certainly be accommodated to the best of our ability. The more specific you are, the more our tour operator can work to make them happen. 
I have the following DIETARY NEEDS OR REQUESTS: 
 *
Required
HEALTH INSURANCE
While the program fee includes a great deal of illness and injury coverage, we require information about additional insurance coverage. Note that Medicare does provide coverage outside the United States. 
I stipulate that I have sufficient health, accident, disability, and hospitalization insurance to cover myself during my participation in the program.
 *
ACKNOWLEDGEMENT
I have read and understand the health information and program requirements and confirm that I am capable of fulfilling the program requirements and that I will be  responsible for my own insurance and my own health and safety. I understand that if St. Olaf College needs further information about my health condition(s) in order to assure that I may safely participate in the Alumni & Family Travel Program or to fulfill the program requirements, I may be asked to provide a physician’s certification.
 *
Type your full name as your electronic signature *
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