Critical Information Form

Please help our travel procedures go smoothly for us all by providing the information to the following questions. Questions related to health are in case of emergency care or treatment. All enclosed information will be treated confidentially by your group leaders; however, submission of this information constitutes permission to pass along your food restrictions to our restaurants and to share medical information with qualified medical or other persons vital to your health and well being.
Street
City
State
Zipcode
Number
Date of Issue
Expiry Date
Place of issue
Arrival Airline
Flight Number
Arrival City (Which city are you arriving in?)
Arrival Day
Date of Arrival
Arrival Time
Departure Airline
Departure Flight Number
Departure City (Where are you traveling from?)
Departure Day
Date of Departure
Departure Flight Time
Address
Phone Number
Address
Phone Number
Name
Phone Number
Insurance Company
Group ID
Issuer ID
Phone Number(s)
If yes, please list them here
Any other details we need to know regarding your allergy/allergies? i.e. Will you be carrying an EPIPEN that we need to be made aware of in case of an emergency?
Other food restrictions
Please email any supporting documents, if needed.
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