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TCU Application Form



Thank you for your interest in our progammes. Please note that Reperio has a rolling admissions policy. This means that it is important to apply early, as some programmes fill prior to their stated deadlines.

Please note that on admission to the programme, payments are refundable of up to 50% until one month prior to the start of the programme, after which there will be no refunds.

Application Materials

Your application will be reviewed on receipt of the following:
• Completed application form
• Initial downpayment
• Copy of passport



Select-travel-programme
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1. Your details
First name(*)
Please type your first name.

Surname(*)
Please type your surname

Address
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Date of birth

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Sex
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T-Shirt Size
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Occupation
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Employer
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E-mail(*)
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Tel (Home)

Mobile

Passport Number
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Passport Cpoy
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Passport Expiry Date

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2. Emergency Contact 1
Name(*)
Please type your first name.

Relationship(*)
Please type your surname

Tel
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Mobile
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E-mail(*)
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Occupation
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Employer
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3. Emergency Contact 2
Name(*)
Please type your first name.

Relationship(*)
Please type your surname

Tel
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Mobile
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E-mail(*)
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Occupation
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Employer
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4. Your doctor’s details
GP/Surgery
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Name
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Telephone
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Address
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5. Diet
Are you vegetarian or vegan? (please specify)
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Details
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Do you have any food allergies?
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Details
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Do you have any special dietary requirements?
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Details
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6. Medical Information
Asthma
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Details
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Bronchitis
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Details
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Heart Condition
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Details
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Fits, fainting or Blackouts
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Details
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Severe Headaches
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Details
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Diabetes
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Details
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Allergies to any known drugs
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Details
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Any other allergies (eg. Material)
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Details
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Travel sickness
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Details
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Back, knee or other joint problems
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Details
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Any injury, break or sprain
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Details
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Other illness, medical condition or disability
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Details
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7. Further medical details
Are you receiving medical or surgical treatment of any kind from your doctor or hospital?
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Have you been given specific medical advice to follow in emergencies?
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If the answer to either of these questions is YES, please give details here (including dosage of any medicines/tablets)
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Signature
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