Name *
Name
Cell Phone
Cell Phone
Do you speak Spanish? *
Do you (and every member in your family) have a current passport(s)? *
Lot of places to serve. We will do our best to accommodate *
We will do our best to honor your request.
Liability Agreement *
I hereby remise, release and forever discharge Circle of Concern, its employees, agents, servants and all other persons, firms and corporations whomsoever of and from any and all actions, claims and demands, whosoever which claimant now has or may hereafter have on account of or arising out of any accident, casualty and/or action which might happen while participating in programs/events. I further understand that there is no Worker’s Compensation or Accident Insurance furnished by Circle of Concern for such programs/events. I acknowledge that I am responsible for any and all personal medical expenses while participating in all programs/events, and agree to hold harmless Circle of Concern of any and all liability that may arise out of such participation.
Add additional family members below (Optional)
Family Member 1
Family Member 1
Check box only if under 18 years old
Family Member 2
Family Member 2
Check box only if under 18 years old
Family Member 3
Family Member 3
Check box only if under 18 years old
Family Member 4
Family Member 4
Check box only if under 18 years old
Family Member 5
Family Member 5
Check box only if under 18 years old

TRIP COSTS

Use the button below to pay the $100/person non-refundable deposit. 

PAY $100 NON-REFUNDABLE DEPOSIT TO SECURE SPOT

TOTAL COST:
$495 for Adult double room occupancy
$545 for Adult single room occupancy
$450 for Children 16 and under

Final Payment: Remaining balance due by 12/11

Once we receive your deposit we will email you with additional information about the trip.  If you have any further questions, please email carol@circleoc.com