WCC - Order Brochure Form

Request A Brochure & DVD

What type of program are you interested in?

Westcoast Connection Itineraries

North American Active Teen Tour	Overseas Active Teen Tour
Baseball Tours	ON TOUR for Students Completing 11th and 12th Grade

360° Student Travel Itineraries

Community Service	Language Programs
Pre-College Enrichment	Global Adventures

360° Family Tours Itineraries

South Africa Family Getaway

Costa Rica Family Escape

Custom Groups

What destination(s) are you interested in?

*Participant's Name:
(First & Last)

Mother's Name:

Father's Name:

Who Completed the Form?:

Participant's Email:

*Parent's Email:

Second Parent's Email:

*Address:

*City:

*State/Province:

*Zip/Postal Code:

Country:

*Phone:
(include area code)

Mom's Cellular:

Dad's Cellular:

Gender:

Date of Birth:
(MM/DD/YYYY)

Age by July 1:

Name of School:

Current Grade in School:

Previous Summer Program:

How can we help you?:

How did you find us?:

Please specify:

Please list the names of any brothers or sisters, their grade and birthdate:

	Name	Current Grade	Birthday (MM/DD/YYYY)
Sibling 1:
Sibling 2:
Sibling 3:

Please list the names and addresses of any friends that would be interested in receiving information about Westcoast Connection / 360° Student Travel.

Would you like to schedule a call with one of our Directors?

We often find that parents want to speak with us directly at a time that is convenient for them. We are available to answer your questions at your convenience. If you would like to schedule a call at a specified time with one of our directors, please fill out the form below and we will call you to speak about your teenager's summer plans.

Person Requesting Call:

Number to Call:

Preferred Day for a Director to Call:

Preferred Time for a Director to Call:

Time Zone :

How did you find us?