Canada Border Services Agency

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Canada Border Services Agency
INFORMATION MUST BE
Pacific Crest Trail Processing Centre
LEGIBLE ON THIS
th
28 – 176
Street, Surrey, BC V3Z 9R9
APPLICATION
PacificCrestTrail@cbsa-asfc.gc.ca
APPLICATION FOR ENTRY TO CANADA VIA THE PACIFIC CREST TRAIL (PCT)
This form can be completed on a computer, or completed by hand using black ink and
BLOCK LETTERS .
Remember to sign and submit with indicated documents.
Please submit completed applications by email address noted above_
Each person entering via the Pacific Crest Trail must complete his/her own application. If under 18
years of age, and not accompanied by a parent or legal guardian, a notarized letter of parental consent
is to accompany this application.
Application email info:PacificCrestTrail@cbsa-asfc.gc.ca By Telephone:1-866-496-3987
PART ”A”
SEX:
NAME (LAST OR FAMILY NAME)
FIRST NAME
MIDDLE NAME(S)
( )M
( )F
OTHER NAMES USED: Eg. Maiden, Nicknames..
BIRTHDATE (DAY-MONTH-YEAR)
PLACE OF BIRTH: CITY, STATE/PROVINCE
COUNTRY OF BIRTH
APPEARANCE
EYE COLOUR
HAIR COLOUR
HEIGHT
WEIGHT
CITIZEN OF:
PASSPORT NUMBER:
SOCIAL SECURITY CARD NUMBER:
STATE AND DRIVER’S LICENCE NUMBER:
PHONE NUMBER
:
E-MAIL ADDRESS:
ADDRESSES YOU HAVE LIVED AT IN THE PAST FIVE (5) YEARS
WITH YOUR
CURRENT ADDRESS :
STARTING
ADDRESS WHERE YOU WANT APPROVED APPLICATION SENT (if different from email address):
EMERGENCY CONTACTS (NAME, ADDRESS, PHONE NUMBER, RELATIONSHIP)
HAVE YOU EVER:
ITINERARY, LENGTH OF STAY WHILE IN CANADA:
YES
NO
..
(A) BEEN CONVICTED OF A CRIME
(
)
(
)
(B) BEEN REFUSED ADMISSION TO CANADA
(
)
(
)
(C) BEEN REMOVED FROM CANADA
(
)
(
)
*NOTE* IF THE ANSWER TO ANY OF THE FOREGOING IS "YES" PROVIDE
DETAILS. Re: Dates, Type of Convictions.
FULL

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