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2025 NYC Adventure Outside the Box - Traveler's Registration Form
Traveler's Information and Documents
Traveler's Full Name (as it appears on Traveler's ID)
First
Middle
Last
Email
(Required)
Enter Email
Confirm Email
Gender
Age
Date of Birth
(Required)
MM slash DD slash YYYY
Type of ID you're traveling with including the State and Country issued
(Required)
Travel I.D./Passport/Driver's License number
(Required)
Please upload a copy of your Travel Documents as noted above
(Required)
Drop files here or
Select files
Max. file size: 50 MB.
Home Address & Phone Numbers
Street
(Required)
City
(Required)
State
(Required)
Zip Code
(Required)
Home Phone
Work Phone
Cell Phone
(Required)
Texting is an important communication tool in NY - may we text this cell number?
Yes
No
Emergency Contact:
Name
(Required)
Relationship
(Required)
Phone Number
(Required)
E-mail Address
(Required)
Accommodation at the Shelburne Hotel
What is your room preference?
(Required)
One Bed
Two Bed
One Bed Deluxe Studio
Are you sharing a hotel room?
(Required)
Yes
No
If so, with whom?
Do you have any special rooming requests or needs?
(Required)
Yes
No
If yes, please describe (lower level floor, proximity to friend or elevator, etc):
NOTE: We will do our best to accommodate your request but are ultimately subject to the hotel's discretion
Are you celebrating a special occasion during the trip (i.e.; birthday, anniversary, etc). If so, please advise:
Additional Information
Do you have any allergies (dietary or environmental)
(Required)
Yes
No
If yes, to what
Please advise of any special food or dietary requirements:
Please advise of any physical condition or medical equipment you may have that could create a hardship or require assistance with stairs or walking
Please advise of any medications that you are currently taking that we should be aware of
Add
Remove
Please provide any additional travel requests or requirements
Please provide any additional information or comments here
COVID- 19 TRAVEL WAIVER ACKNOWLEDGEMENT
(Required)
I, and my heirs, in consideration of my participation in Green Box's New York City trip taking place from April 22, 2025 through April 27, 2025 hereby release Green Box, its officers, employees and agents, and any other people officially connected with this event, from any and all liability for damage to and/or loss of, personal property, legal entanglements, imprisonment, death, loss of money, injury or sickness from whatever source, including Covid-19 (see below), which may occur while participating in this event. I am fully aware of the risks of participation. I hereby state that I am in sufficient physical condition to accept the level of moderate physical activity that may be required. I also understand that participation in this program is strictly voluntary, and I freely choose to participate. I understand that Green Box does not provide travel insurance nor medical coverage for me and that it is strongly recommended that I secure coverage independently. I verify that I will be responsible for any travel insurance or medical costs I incur.
COVID-19 TRAVEL WAIVER ACKNOWLEDGEMENT By consenting to this agreement, I acknowledge the contagious nature of COVID19 and voluntarily assume the risk that I may be exposed to, or infected by, COVID-19 while traveling. Such exposure or infection may result in personal injury, illness, permanent disability, and possible death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself including, but not limited to, personal injury, disability, and death. By signing this agreement, I accept ultimate responsibility for myself and those traveling directly with me, to have all the necessary provisions for travel (which include and are not limited to; COVID test results, proof of vaccination for COVID, pre-travel questionnaires, etc.) Moreover, I understand that I should assume responsibility for the necessary documents (such as COVID test results, proof of vaccination, pre-travel questionnaires, etc.) considering COVID-19, in order to travel to my specific destination. By signing your name below, you are acknowledging your receipt of this waiver and agree to its conditions.
I acknowledge the receipt of this waiver and agree to its conditions
