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ActionQuest scuba diving group

Enrollment Application

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1Student Info
2Parent /Guardian Info
3Adventure Info & Terms
4Insurance & Deposit
5Review & Submit
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1. Student Information

Student Details

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Student Home Address

We mail all correspondences to this address prior to, and after the program. This address should be valid for a minimum of 3 months after your adventure ends.

 


School Information

 


Your Previous Experience

1. Scuba: Will you be certified or have a referral by summer?*
2. Sailing: Do you have any experience?*

 


Medical Information

1. Does the student have any health considerations, allergies or disabilities we should be aware of?*

Please use the field below to give us a sense of these considerations.

We're not necessarily looking for a full medical history at this point (a completed medical form is required for all students before the program), yet we use the information you give us now to help determine whether the trip selected is appropriate and that the student has a high likelihood of success. For example, certain respiratory or pulmonary complications may restrict the ability to scuba dive, or acute allergic reactions to common food items can be a concern given our remote location.

2. At any point in the last 12 months has the enrolling student been under the care of a therapist, psychiatrist or psychologist?*

The very nature of an AQ Adventure creates a living, social, and working dynamic that is very different from the home environment. For this reason, if the student has been under the care of a therapist, psychiatrist, or psychologist at any point in the last 12 months, we ask that the Counseling Professional complete a specific questionnaire. Exceptions to this requirement may be alumni who have previously submitted this form and been accepted.

Please enter your email address below, and we will send you the Counseling Questionnaire along with some more information to forward to your Counseling professional.

Please do not enter your Counseling Professional's email address as they will not understand the context of the request we will be sending you. We suggest that you forward the information we provide to your Counseling Professional under separate cover.
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3. ActionQuest currently requires all students to be fully vaccinated* for COVID-19 before the voyage start date.
Please indicate your understanding and agreement with this requirement below. For information on why we are currently requiring this, in addition to the definition of "fully vaccinated"* click HERE

 

 


2. Parent / Guardian Information

 

Please provide us with as much information as you can.

 

 


 

First Parent / Guardian Information

Copy Parent 1 Address

 


 

Second Parent / Guardian Information

Auto Fill from Parent 1

 

 


3. Adventure Selection, Terms & Agreements

a. Adventure Selection



b. Participant Terms Agreement & Acknowledgment and Assumption of Risks & Release and Indemnity Agreement

Read the following carefully. These documents contain important information and may affect your legal rights if an injury or other loss occurs.

Once we have processed the enrollment application and created a student portal, the student will be asked to generate and sign a digital version of these agreements. In the meantime, feel free to download a copy by clicking here https://www.actionquest.com/release.

Once we have processed the enrollment application and created a student portal, you will be asked to generate a digital version of these agreements, which must be signed by BOTH student and parent/guardian. In the meantime, feel free to download a copy by clicking here https://www.actionquest.com/release.

 

Participant, please check the box below to indicate your agreement with the Participant Terms Agreement outlined above.*
Parent, since the Participant will be under the age of 18 or some or all of the voyage, please check the box below to indicate your agreement with the Participant Terms Agreement outlined above.*

 

Participant, please check the box below to indicate your agreement with the Acknowledgment and Assumption of Risks & Release and Indemnity Agreement outlined above.*
Parent, since the Participant will be under the age of 18 or some or all of the voyage, please check the box below to indicate your agreement with the Acknowledgment and Assumption of Risks & Release and Indemnity Agreement outlined above.*

 

 


4. Insurance, Travel Protection & Deposit

a. International SOS / MedAire Membership & Emergency Evacuation Insurance (required)

Because we want to be prepared for every scenario, we've partnered with International SOS and MedAire, the world's leading medical and security risk services company to provide complete emergency evacuation coordination and insurance for our students. A critical piece of this plan is that International SOS / MedAire membership also provides 24/7 access to a robust network of doctors and security services both before and during the trip. The cost of the membership is $115 per student for Adventures up to 21 days, $195 for 40 and 50-day trips, and $250 for programs between 70 and 90 days . While we understand that this is an additional fee, we believe our students and their families will appreciate the value of International SOS and MedAire's services along with the peace of mind that this resource brings. We will add the membership fee as a separate item on your tuition invoice, and prior to the program we'll send all of your International SOS membership / MedAire details.

Please note that this is not Tuition or Medical Insurance. Those seeking to protect their tuition investment should consider the optional insurance packages outlined below.


b. Travel Protection (Optional)

Life is uncertain, so it’s important for students and parents to consider protecting their tuition investment. Purchasing Travel Protection provides coverage for unexpected travel emergencies with benefits such as accident & sickness medical expenses, trip delay, and trip interruption coverage. In some cases, you can also purchase the optional Cancel For Any Reason benefit that allows an additional degree of flexibility should your plans change before the summer.

AH-4754

 


d. Discount / Scholarship Code

Discount Code
Early Enrollment Savings apply to non-invitational programs of 14 days or longer. Savings codes can’t be combined with each other.

 


b. Deposit Details & Payment Authorization

Authorization for a one-time charge to your credit card to pay the application deposit and GXG Travel Protection Plan (if selected) according to the Terms and Agreements. Standard deposit is $1000 USD when enrolling through February 28/29, then $1500 USD on/after March 1.

 


e. Credit Card Information

Discover
MasterCard
Visa
Maestro
Supported Credit Cards: Discover, MasterCard, Visa, Maestro
 

 

 


5. Review & Submit Your Application

 

Please review the information below for accuracy. If you need to make any changes, simply click on the step links above to jump to that page.

Student Information

Name {student first name:1} {student middle name:3} {student last name:2} Preferred Name {student preferred name:4}
Date of Birth {date of birth:5} Country of citizenship {country of citizenship:18}
Sex {sex:7} {transgender:20} Height {height:8}
Weight {weight:9} lbs. T-shirt Size {t-shirt size:10}
Phone {student primary phone:284}   {student primary phone type:159} Email {student email 1:11}
Mailing Address {student street address 1:29}, {student street address 2:30}
{student cIty:31}, {student state/province:175:value} {student zip:32}
{student country:34}
School Info {school:14}
Current Grade {grade:15}
How I heard about ActionQuest: {Learn About:52}

Parent/Guardian Information

First Parent/Guardian Information (if applicable) Second Parent/Guardian Information (if applicable)
Relationship {parent/guardian 1 relationship:136}   {parent/guardian 1 relationship:126} Relationship {parent/guardian 2 relationship:137}   {parent/guardian 2 relationship:145}
Name {parent/guardian 2 first name:98} {parent/guardian 1 first name:99} {parent/guardian 1 last name:100} Name {parent/guardian 2 first name:113} {parent/guardian 2 first name:112} {parent/guardian 2 last name:111}
Email {parent/guardian 1 email:114} Email {parent/guardian 2 email:115}
Primary Phone {parent/guardian 1 primary phone:285}   {parent/guardian 1 primary phone type:103} Primary Phone {parent/guardian 2 primary phone:287}   {parent/guardian 2 primary phone type:109}
Secondary Phone {parent/guardian 1 secondary phone:286}   {parent/guardian 1 secondary phone type:104} Secondary Phone {parent/guardian 2 secondary phone:288}   {parent/guardian 2 secondary phone type:107}
Mailing Address {parent/guardian 1 street 1:138}, {parent/guardian 1 street 2:139}
{parent/guardian 1 city:140} {parent/guardian 1 state:173:value} {parent/guardian 1 zip:142} {parent/guardian 1 country:143}
Mailing Address {parent/guardian 2 street 1:147}, {parent/guardian 2 street 2:148}
{parent/guardian 2 city:149} {parent/guardian 2 state:174:value} {parent/guardian 2 zip:151} {parent/guardian 2 country:152}


Your Previous Experience

Scuba: Certified or have referral by summer? {Scuba Certs:239}   {What Scuba Certs:241}
Sailing: Do you have experience? {Sailing Experience:240}   {What Sailing Experience:242}


Medical Information

Any medical considerations?: {health considerations:66}   {What health considerations:71}
Under the care of a therapist, psychiatrist or psychologist in the last 12 months?: {Psychiatrist:70}


Participant Terms Agreement

{student terms agree:176:value}
{parent terms agree:268:value}

Acknowledgment and Assumption of Risks & Release and Indemnity Agreement

{student participant agree:177:value}
{parent participant agree:270:value}

Scholarship / Discounts

{Trip Discounts:281}



Trip Insurance

{Trip Insurance:280}


Trip, Tuition & Deposit Overview

{Deposit Calculator:282}


Payment Information

Once program availability and suitability has been verified, {Total:191} US Dollars will be charged to your Credit Card.

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Confirmation Email

 

Press the Submit Button Only Once

Complete your application by pressing the submit button below. Form processing time depends on your internet speed, so please only press the button once in order to avoid multiple submissions.

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