No Barriers Family Expedition Thailand 2020

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Page 1

NB Logo

We are excited you’ll be joining us on this incredible international expedition. We require detailed information in the following registration form to safely and effectively execute our programs. 

*Please set aside adequate, uninterrupted time to complete the form. 

Before you begin:

  • Please complete this registration form on a computer, not on your phone.
  • If you have a valid passport please scan the entire content of the picture page to upload
  • If you don’t have passport yet you can still complete the form
  • Please have your medical insurance card and information available


Fill out the information below, then click Next to proceed.


Page 2

Registration Questions

Health Questions

No Barriers USA requires all participants to complete this medical assessment. Please help us optimize the medical review process by:
1.) Be Honest. NBUSA wants you to participate and we strive to accommodate most medical conditions. It is in everyone's best interest to disclose medical information upfront.
2.) Be Thorough. Fill out the medical fields and forms completely. Incomplete or blank answers will require NBUSA to contact you and may delay your acceptance to the program.
3.) Communicate Changes. If there are any new medical conditions or changes in medical status or medications before your program starts, update them here and contact NBUSA immediately at 970-484-3633. Unreported changes may result in dismissal.
4.) Be Timely. Be sure you complete this online assessment by your group's deadline and have your Health Care Provider review your submission and sign Health Care Provider form. NBUSA will review this health assessment, as well as the separate Health Care Provider Form, and contact you if questions arise.
General information

Medical History:

Yes No

Yes No

Medications: Participants must bring AN EXTRA supply of any prescription medications that they will need to take. Participants who have had an anaphylaxis reaction must provide their own epi-pens. 

Yes No

Altitude Sickness: When traveling above 8,000 feet, does the participant have a history of:
Yes No Unsure
Sickle Cell: Has the participant or participant’s parent(s)/sibling(s) tested positive for:
Yes No Unsure
Substance Use: Does the participant:
Yes No

Page 4

Insurance Information

No Barriers USA requires that a licensed medical professional (Medical Doctors, Doctors of Osteopathy, Licensed Nurse Practitioners and Physician Assistants are all acceptable) review your above responses. DIRECTIONS:  
1. Please download and print the Health Care Provider Form (link below).  
2. Print the answers to the medical questions you submitted here, which will be emailed to both the participant and the guardian's email addresses.  
3. Bring the printed versions of the Health Care Provider Form and your responses to your appointment with your medical professional.  
4. Have your medical professional review and evaluate your health status and sign the Health Care Provider form.  
5. Deliver the signed Health Care Provider Form, the Minor Consent to Travel Form and the Passport Carrying Consent Form (links below) to your Group Leader.
Health Care Provider and Additional Forms:

Adult Medical Release Waiver 

Booking Terms and Conditions (right click here to open in a new tab)

Student Risk and Release Agreement (right click here to open in a new tab)

Adult Risk and Release Agreement (right click here to open in a new tab)


EARLY BIRD SPECIAL: Total trip cost per participant (without trip insurance): $2,695*
*Participants need to pay in full in order to get the discount. Price only valid until January 1, 2020.

Payment summary/schedule:
  1. Mandatory Deposit: $200, due upon completion of this registration as outlined in the booking conditions.
  2. (Optional Trip Cancellation Insurance: $109, due upon completion of registration if selected-- see below)
  3. Remaining $2,495 after $200 deposit, to be paid in five equal monthly payments of $499, automatically charged to the card provided below on the 1st of each month, December 2019 - May 2020 

If you choose not to purchase trip cancellation insurance during registration, you can purchase it up to 75 days before the departure of the trip by sending (or dropping off) a check made out to "No Barriers USA" for $109 with the memo "trip cancellation insurance." Our address is 224 Canyon Avenue, Suite 207, Fort Collins, CO 80521.
Payment Information

Billing Address

Please only hit the "Submit" button once to avoid multiple payment submissions!