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Application Request

Your First & Last Name:*

Email Address:*

Address:*

City:*

State:*

Zip:*

Cell Phone:*

Gender:*

 

Male
Female

Are you a U.S. citizen?*

 

Yes
No

Are you interested in taking this course for credit:*

Credit
Not for Credit

Are you currently taking classes at Regent University:*

Yes
No

If you are not a Regent student how did you hear about this trip:

If you are not a current Regent University Student You can skip the next 5 questions:

 

Regent University Students please answer the following questions

Which Regent University school(s) are you enrolled in (please list any joint degree schools):

School of Communication & the Arts

School of Divinity

School of Education

School of Global Leadership & Entrepreneurship

School of Government

School of Law

School of Psychology & Counseling

School of Undergraduate Studies

What is your Degree:

What is your Major:

Have you talked to your advisor to confirm that this course will be used towards your degree:

Yes
No

Who is your course advisor for your current Regent Program:

Student I.D. #:

PROOF OF TRAVEL AND HEALTH INSURANCE, PROOF OF PASSPORT AND TRAVEL RELEASE FORM
Forward copies of proof of travel and health insurance, proof of valid passport, and your completed and signed travel release form to Margie Ackerman no later than May 1, 2014.

Regent University
School of Communication & the Arts
Attn: Margie Ackerman
1000 Regent University Drive, COM 240
Virginia Beach, VA 23464
Fax: (757) 352-4291
Email: mackerman@regent.edu


I understand that only Regent students confirmed to be in good standing by Student Services and the Business office will be permitted to attend this course.

Proof of Health Insurance for all Participants
I am responsible for securing medical emergency coverage for overseas for the period of this trip through your medical provider. You should take a copy of your insurance card when traveling abroad.

Your coverage needs to begin no later than the date of your initial departure to the United Kingdom and must remain in effect for the duration of the trip. Please forward a copy of your insurance arrangements to Margie Ackerman that describes medical coverage for overseas.

Travel Insurance for all Participants
I understand that all participants are required to obtain travel insurance through ACE for a $50 fee.
Take a copy of the insurance card when traveling abroad. Please read the brochure to be aware of benefits.

Insurance Card
Brochure

Proof of Valid Passport & Travel Visa
I understand that a VALID PASSPORT IS REQUIRED FOR THIS TRIP and that it must be valid for at least 6 months beyond initial entry into the United Kingdom. I am forwarding a copy of my passport to Margie Ackerman. It is also recommended that you carry a copy of your passport with you on the trip.

I understand that I must register travel plans with U.S. State Department

All U.S. American participants must register their time abroad with the U.S. State Department.

Travel Release Form
I have reviewed, completed and signed the Regent University Travel Release Form. The same Code of Conduct contained in the Student Handbook, page 36, applies to learning abroad programs and activities. I will forward a copy of the completed form to Margie Ackerman.
www.regent.edu/admin/stusrv/docs/StudentHandbook.pdf

Minimum Number of Participants
I understand that unless a minimum of 10 applications with deposits have been received by the deadline of February 7, 2014, the trip will be cancelled and a full refund of the program fee will be issued to me. However, the refund will not apply to the travel insurance through ACE.

Health Advisory & Special Accommodations
I understand that this program can be rigorous, and some of the events may require demanding physical activities. Therefore, participants should possess the ability to:

    1. Walk one mile without resting
    2. Stand for 30 minutes without sitting
    3. Climb three flights of stairs without assistance
    4. Hear instructions in a group setting with environmental noise present
    5. Read and understand written instructions and signs
    6. Step in and out of buses or shuttles.

Regent University may be unable to provide special accommodations for people with disabilities. If someone needs accommodation or assistance, that person must bring a companion/assistant at full price. Also, those who have a health or mental condition that may interfere with participation in program activities, need to consult with their physician to determine if they are able to participate in a physically demanding study abroad program. If I have any questions regarding special accommodations for people with disabilities, I will contact Dr. Sherry Todd at 757-352-4842 or at stodd@regent.edu

Liability
Regent University does not assume liability for injury, damage, loss, accident, delay, or irregularity which may be occasioned by reason or defect, through the acts or defaults or any company or person engaged in conveying the participants of this tour or in carrying out the arrangements of the tour, or as direct or indirect results of acts of nature, breakdowns in machinery or equipment, acts of governments or other authorities, de jure or de facto, wars, whether declared or not; hostilities, civil disturbances, strikes, riots, theft, pilferage, epidemics, quarantines, medical or customs regulations, loss or damage resulting from improper passports, visas, or other documents or from any causes beyond the control of the University. The University can accept no responsibility for loss or additional expenses due to delay or changes in schedule or other causes. We have the right to refuse to accept or retain any tour participant should such person's health or general deportment impede the operation of the tour to the detriment of other participants. All rates are based on tariffs in effect at the time the tour was planned and are subject to change in the event of adjustments therein. Baggage is carried at the owner's risk and baggage insurance is recommended. The issuance of tickets and vouchers will be deemed to be consent to the above conditions.

The participant's signature below (type your name) and participation in this trip constitute acceptance of this provision and agreement by such participant that Regent University shall not be liable or responsible in any way whatsoever for any inconvenience, loss, damage, or injury arising out of or in connection with such tour services. By typing my name below, I acknowledge that I have read and fully understand the conditions and responsibility area of the enrollment application and verify the information I have provided as truthful and correct.

Type Name:

Date:

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