The HBCU Kid College Tour Registration Form Step 1 of 4 25% Name* First Last STUDENT INFORMATIONAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Grade Level*6789101112Shirt Size*Youth SmallYouth MediumYouth LargeYouth XLSmallMediumLargeX-Large2X-Large3X-Large PARENT/GUARDIAN #1 INFORMATIONName* First Last Phone*Email* PARENT/GUARDIAN #2 INFORMATIONName First Last PhoneEmail Parental Consent I agree to the parental consent policy.I certify that I have read and reviewed the following with my child: conduct agreement, medical release form, what to bring/what not to bring, and permission to use image. I give my child permission to attend the above named event hosted by The HBCU Kid™. I will hold neither The HBCU Kid™and its officers responsible for any actions, mishaps, or loss (including death) that may occur during this event. Furthermore, I understand that if my child is involved in any illegal actions (including, but not limited to possession of illegal substances, alcohol, cigarettes, tobacco, weapons, weapon look-alikes, or fake identification) or inappropriate conduct (including, but not limited to fighting, harassment, sexual misconduct, profanity, theft, failure to comply with curfew, or disrespect toward chaperones or tour guides), I will be contacted immediately and in extreme circumstances, my child may be dismissed from the tour and I may be required to travel at my own expense to retrieve my child. I understand that any and all payments will not be refunded. HEALTH INFORMATIONAre you vaccinated?* Yes No If yes, which vaccine? Email a copy of your vaccination card to thehbcukid@gmail.com COVID-19: The HBCU Kid will require everyone to get a PCR test 24-48 hours before departure. Please email your test results to thehbcukid@gmail.com. You will not be able to travel without your test results. We highly recommend you get vaccinated. PLEASE CHECK HERE IF THE CHILD IS NOT COVERED BY HEALTH INSURANCE.Name of Health Insurance Name of Policy Holder Group Name Policy Number Emergency Contact Number*Emergency Contact NumberEmergency Contact Number Does your child have any illness, health conditions, mobility limitations, or communicable disease that we should be aware of?* Yes No If so, please list:Does your child have an allergy to any foods or medications?* Yes No If so, please list:Is your child required by a medical doctor to take any medications?* Yes No If so, please list:Does your student have special dietary needs?* Yes No If so, please list: Δ