2025 Summer Serve Trip Registration

Please enter the the registration information for one student at a time.

First name

Please enter it exactly as shown on the student's government ID. If they do not have one, use their legal name.

Last name

Please enter it exactly as shown on the student's government ID. If they do not have one, use their legal name.

Student Email

(Must be unique to each registrant. Use student's email if you can)

Student Birthday

Month

Day

Year

Student Gender

Male

Female

Parent Email

Parent 2 Email (optional)

Student's Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Parent/Guardian (full names) where student resides

Parent's Phone

Emergency Contact Name

Emergency Contact Phone Number & Secondary Phone Number

Emergency Contact Email

Relationship to Participant

Date of last Tetanus Shot

List any medical conditions or dietary restrictions, including food or drug allergies

List any medication you take regularly, what you take them for and side effects

Please list any physical conditions or disabilities that will require additional accommodations

Do you presently have health insurance?

Yes

No

Insurance Company

Does your insurance company require Pre-authorization for medical treatment?

Yes

No

Insurance Subscriber's Name

Policy Number

Group Number

Insurance Phone Number

Has your student been on a serve trip before?

Yes

No

Are there any skills or talents that would be helpful for the host team to know about?

Is there anything else you would like the team to know about your student?

Colorado Serve Trip 2025

Pay online: PayPal, Apple Pay or Credit Card payment for Student traveler$257.62

Send payment: Will send check or cash payment for Student traveler$0

*Online payment $250 plus $7.62 online service fee

2025 SUMMER SERVE TRIP TO

2025 Summer Serve Trip Registration