Ready Registration Form (Page 2 of 3) in pdf

Payment information

 The cost of the trip is $462 per student (surcharge may be applied if group size isn’t meant). The full amount may be paid upon

registration, or the cost may be divided, three payments (an installment fee of $5 is included with each partial payment.)

 A minimum deposit of $159 must accompany this registration form and be postmarked by December 11, 2015.

 The last two payments will be due on January 22

and March 25

, 2016. A $25 late fee will be added to all payments received

after these dates.

 Payment may be made by credit card or with a U. S. Postal Service money order or cashier’s check made out to “Historical

Adventures Inc.” PERSONAL CHECKS and other MONEY ORDERS WILL NOT BE ACCEPTED.

 All payments and registration information if not done online must be mailed to:

Historical Adventures Inc., 360 South Camp Street, Red Lion, PA 17356

 Registration is on a “first come, first served” basis, so students may be placed on a waiting list

Please circle the appropriate box for the amount of your payment:

Cost

Classic

Basic

Essential

Purchased

Student

Credit card # ________________________________________________

$29

$21

$17

with



Discover

chaperone

With optional

$41

Exp. Date ____________________

Visa

cancel anytime

MasterCard

100% payment of $462

V-code __________________ (last three digits in the signature block)

minimum deposit of $159

(includes $154 deposit and $5 installment fee)

_______________________________________________________

other amount _____________

authorized signature

(must exceed $159, and must include the $5 installment fee)

Automatic Payment Plan:

Check this box if you are paying the minimum payment, using a credit/debit card, and would

like to have the final two payments made automatically. (If you check this box, two payments of $159 each will be charged to

your account on January 22

and March 25

, 2016. )

 Installment payments #2 and #3 may be made online at

on our secure website. Just click “for

Parents.” then “Payment”. You also can make payments by mail or by phone (717.741.3800.)

TERMS & CONDITIONS

Release of Medical Liability: In case of emergency and a family member cannot be reached by phone, I authorize a chaperone to obtain medical

attention for the participant shown.

Liability Disclosure: Historical Adventures Inc, and it agents act only in the capacity of agents for the passengers in all matters pertaining to hotel

accommodations, sightseeing tours and transportation whether by railroad, motorcoach, car, cruise ship or plane, and as such they shall not be liable

for any injury, personal injury, damage, loss, accident, delay or irregularity which may be occasioned either by reason of any company or person

engaged in conveying the passenger, or in carrying out the arrangement of the tour or otherwise in connection therewith. Nor is Historical

Adventures Inc. responsible for the supervision of students’ activities, behavior, or medical concerns. Historical Adventures Inc. reserves the right to

make substitutions of comparable quality in the itinerary where necessary. The right is also reserved to decline to accept or retain any person as a

member of any party at any time.

Travel Insurance Program: To check out details on the different travel insurance options please go to

Refunds: ________ Please initial here to decline participation in the travel insurance program. You must decline at time of registration deposit. As a

result of this tour having been planned and paid for far in advance, refunds will not be made. If you are unable to attend the trip and have not gotten

trip insurance, contact the offices of Historical Adventures by email as soon as possible. It may be possible to replace you with someone from the

waiting list.

Student Behavior: Students are expected to uphold all school rules and to follow the directions of their teachers and chaperones throughout the entire

trip. If at any time prior to the trip an administrator or group of teachers feels that a student’s behavior warrants his/her removal from the trip, it is the

policy of Historical Adventures Inc. to respect that decision and remove the student from the trip without a refund.

REQUIRED SIGNATURES

Parent signature(s) grants permission for their child to attend the trip and indicates agreement to the “Terms & Conditions” of the tour package.

X Signature

Date

Student’s signature indicates an agreement to follow all school rules and chaperones’ directions while on the trip. It is also an acknowledgement that poor choices regarding

behavior will ultimately affect his or her involvement in the trip.

X Signature

Date

Ready Registration Form Page 2

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