Register for an Earth Explore Educational Adventure. 

Students and Parents! Join your local group quickly and easily by completing the form below.  

After submitting this registration form, you'll be directed to a secure payment page to make your deposit by credit card, or check. 

Already registered?  To make a payment on an exisiting account, click here. (If you're a teacher, you can register on this page.)

Student Registration Form 2011-2012
	*Required
	*Adventure Choice	Costa Rica Adventure Big Island (Hawaii) Adventure Alaska Adventure Rockies Adventure Italy Adventure Yosemite and Monterey Adventure
	*Program Year	2012
	Teacher leading group
	(If not known, student grouping is by school or city of residence)
	Student's Information
	*Student's First Name			*Last Name
	Preferred name			*Gender	Female Male
	*Date of Birth
	*Home Address			*City
	*State			*Zip
	*Home Phone			Parent Cell
	*Parent Email address			*School
	*Current Grade	5 6 7 8 9 10 11 12		*School City
	School Year Ends			Adult T-Shirt Size	Small Medium Large Extra Large
	Parent/Guardian Information
	*Father's name			Address	If different
	*Mother's name			Address	If different
	*Emergency Contact (besides parents)			*Phone
	Student's Other Information
	Interests and Hobbies			Favorite subject?
	*Allergies, food needs	Parents, list known allergies or special food needs
	Referred by a friend?	Yes No		If yes, name of friend who referred you
	Like to Recommend a Teacher?			School
	Deposit Information
	Name on Credit Card to be used (for cross referencing payment)			I will send a deposit by check (required within 10 days)
	By submitting this form I acknowledge that I have read, understand, and agree to the program Terms and Conditions, as well as the Student Rules and Guidelines. read as pdf     read as Word document