Please complete the form below to register for the 2026 Harborside Academy Bali Trip. All submissions will be reviewed by the trip leaders at Harborside Academy for final admission onto the trip.

Student's Name (Full legal name as it appears on a legal document to be used for flying)

First Middle Last

Student's gender

Student Email Address

Student Phone Number

Student Date of Birth

Mailing Address

Emergency Contact Name

Emergency Contact Relationship To Student

Emergency Contact Email Address

Emergency Contact Phone Number

Optional Second Guardian Email Address

T-shirt size (Adult mens and womens sizes- XS - XXL)

Pay deposit