To fill the Enrollment Form please view the Desktop Version.
 
Enrollment Form
*CAMP Name :
BATCH DATE :
PARTICIPANT DETAILS
*Participant’s Full Name :
Photo : (Recommended Size: 150 X 150 pixel)
Gender :
Date Of Birth :
Nationality :
*Participant’s Email I.D. :
School / Academic Institution :
Institution Address: :
City:
State :
Pincode :
Residential Address: :
City:
State :
Pincode :
*Res. Tel. No. :
Fax No. :
Mobile No. Father :
Mobile No. Mother :
HOW DID YOU KNOW ABOUT THIS CAMP?
Newspaper          School          Friends             Mailer
Any other
PARENT / GUARDIAN DETAILS
Name of Father :
Occupation :
Office Name & Address :
City:
State :
Pincode :
Email:
Name of Mother :
Occupation :
Office Name & Address :
City:
State :
Pincode :
Email:
Emergency Contact Person’s Name other than parent :
Tel No.:
Mobile:
ALLERGIES DETECTED
Food
Drug
Other Allergies
Prescribed medicine in case of contraction of allergies
ASTHMA : 
Yes No Use of Asthma Pump Nebulizer
Current Medications if any :
Dosage Quantity and Details:
Please make sure any medications your child needs for the trip are clearly labeled with child’s name, name of trip, Dosage & time, any special instructions
Participant’s need an up-to-date TETENUS shot prior to the trip. Participant’s last Tetanus immunization (DPT, Td)
Blood Group with Rh factor
Parent / Guardian Agreement
I authorize trip counselors to obtain initial emergency medical care for my child
PREFERENCE DURING MEALS
Jain Vegetarian without eggs, roots, onion, garlic, potato, tubers and sprouts, mayonnaise Vegetarian with eggs  
Vegetarian without eggs  Non Vegetarian
PARTICIPANT WEARS
Spectacles Lenses of Power( +  / -)

PARTICIPANT’S TRAVEL PLANS
TRAILBLAZERS TO ORGANISE ONWARD & RETURN FLIGH
PARENT/GUARDIAN WILL ORGANISE ONWARD & RETURN FLIGHT**  
Participants who have chosen this option, kindly fill in the following details 
I will arrive by  :   on at  a.m./ p.m  on date
I will return by  :  on at  a.m./ p.m  on date
 
PAYMENT DETAILS
Cash Cheque   NEFT/ RTGS

Cheques to be drawn in favour of TRAILBLAZERS ADVENTURE TRAVEL PVT. LTD.

I have paid  Rs. camp fees   +    Airfare of Rs. in Cash /
Cheque No.
Ref No.
Dated:
Bank Name:
Payment through NEFT/ RTGS:
Account Name: Trailblazers Adventure Travel Pvt. Ltd.
Bank Name: IDBI Bank Ltd.
Account Number: 0753102000001328
Branch: Vasant Vihar.Thane (W), Maharashtra.
Bank IFSC Code: IBKL0000753
Branch Swift Code: IBKLINBB004
Branch Address:
Emerald Plaza, Block IV- G6,
Hiranandani Meadows, Glady’s Alwares Road, Off. Pokharan Road No.2,
Vasant Vihar, Thane (W),
Maharashtra - 400610, India.
 
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Parent / Guardian Declaration
I confirm that the participant of the programme is mentally and physically fit to undergo activities of the camp. I / We will not hold Trailblazers or Associates responsible for unforeseen circumstances or loss sustained by him/her during the camp.