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Angela Barr
Great Escapes Travel, LLC
Black Disney Moms Group Cruise
Sep 2, 2024 to Sep 6, 2024
Disney Wish - 4-Night Bahamian Cruise from Port Canaveral, FL
<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Black Disney Moms Group Cruise Quote Request Form"/> <field type="paragraph" subtype="p" label="&nbsp;Submit this form to request a Quote for this Cruise.&nbsp; You will receive your Quote within 1 -3 business days (as long as you provide us with all requested information).&nbsp; &nbsp;NOTE:&nbsp; Please don't submit this form unless you are serious about joining us on this Cruise.&nbsp; Thank you!"/> <field type="header" subtype="h1" label="Lead Passenger"/> <field type="paragraph" subtype="p" label="Be sure that all names listed&nbsp; below match the way they appear on government issued photo ID (ex. Passport, Drivers License or State ID)"/> <field type="text" label="Prefix" description="ex. Mr. Mrs. Ms. Dr." name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" description="Jr. Sr. I II III" name="suffix" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Address"/> <field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="header" subtype="h1" label="Travel Party"/> <field type="paragraph" subtype="p" label="Please provide full names and birthdates for the other Passengers that will be booked into the Stateroom with you.&nbsp; Include Prefixes (Dr., Mr., Mrs., Ms., Mstr and Miss) and Suffixes (i.e. Jr., Sr., I, II, III)&nbsp; where needed.&nbsp; &nbsp;[Ex. Dr.&nbsp; John Doe Sr. or Mrs. Jane Doe)&nbsp; NOTE:&nbsp; The maximum capacity in most Staterooms is 4 passengers.&nbsp;"/> <field type="header" subtype="h1" label="Passenger #2"/> <field type="text" label="First and Last Name" name="first-and-last-name" subtype="text" className="form-control"/> <field type="date" label="Birthday" name="date-1681253070913" className="form-control"/> <field type="header" subtype="h1" label="Passenger #3"/> <field type="text" label="First and Last Name" name="text-1681253185083" subtype="text" className="form-control"/> <field type="date" label="Birthday" name="date-1681253156483" className="form-control"/> <field type="header" subtype="h1" label="Passenger #4"/> <field type="text" label="First and Last Name" name="text-1681253182473" subtype="text" className="form-control"/> <field type="date" label="Birthday" name="date-1681253189169" className="form-control"/> <field type="header" subtype="h1" label="Passenger #5"/> <field type="text" label="First and Last Name" name="text-1681253112409" subtype="text" className="form-control"/> <field type="date" label="Birthday" name="date-1681253114948" className="form-control"/> <field type="radio-group" required="true" label="Is everyone in your party a US citizen?" description="If not we need to know so that we can advise you properly" inline="true" name="is-everyone-in-your-party-a-us-citizen"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h1" label="Stateroom Information"/> <field type="radio-group" required="true" label="Number of Staterooms needed" inline="true" name="number-of-staterooms-needed"> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> </field> <field type="radio-group" label="If you are booking more than one Stateroom, should the Staterooms be?:" inline="true" name="if-you-are-booking-more-than-one-stateroom-should-the-staterooms-be"> <option label="Connecting" value="connecting">Connecting</option> <option label="Side by side" value="side-by-side">Side by side</option> <option label="Nearby on the same deck" value="nearby-on-the-same-deck">Nearby on the same deck</option> </field> <field type="checkbox-group" required="true" label="What Stateroom Category are you interested in booking?&nbsp;" description="If you are booking more than one Stateroom select all of the Stateroom categories you want to book." name="what-type-of-cabin-are-you-interested-in-"> <option label="Concierge One Bedroom Suite with Verandah [Balcony] (sleeps 5)" value="concierge-one-bedroom-suite-with-verandah-balcony-sleeps-5">Concierge One Bedroom Suite with Verandah [Balcony] (sleeps 5)</option> <option label="Concierge Family Ocean View Stateroom with Verandah [Balcony] (sleeps 5)" value="concierge-family-ocean-view-stateroom-with-verandah-balcony-sleeps-5">Concierge Family Ocean View Stateroom with Verandah [Balcony] (sleeps 5)</option> <option label="Concierge Family Ocean View Stateroom (sleeps 4 to 5)" value="concierge-family-ocean-view-stateroom-sleeps-4-to-5">Concierge Family Ocean View Stateroom (sleeps 4 to 5)</option> <option label="Deluxe Family Ocean View Stateroom with Verandah [Balcony] (sleeps 4 to 5)" value="deluxe-family-ocean-view-stateroom-with-verandah-balcony-sleeps-4-to-5">Deluxe Family Ocean View Stateroom with Verandah [Balcony] (sleeps 4 to 5)</option> <option label="Deluxe Ocean View Stateroom with Verandah [Balcony] (sleeps 3 to 4)" value="deluxe-ocean-view-stateroom-with-verandah-balcony-sleeps-3-to-4">Deluxe Ocean View Stateroom with Verandah [Balcony] (sleeps 3 to 4)</option> <option label="Deluxe Family Ocean View Stateroom (sleeps 4 to 5)" value="deluxe-family-ocean-view-stateroom-sleeps-4-to-5">Deluxe Family Ocean View Stateroom (sleeps 4 to 5)</option> <option label="Deluxe Ocean View Stateroom (sleeps 3 to 4)" value="deluxe-ocean-view-stateroom-sleeps-3-to-4">Deluxe Ocean View Stateroom (sleeps 3 to 4)</option> <option label="Standard Inside Stateroom (sleeps 3 to 4)" value="standard-inside-stateroom-sleeps-3-to-4">Standard Inside Stateroom (sleeps 3 to 4)</option> </field> <field type="radio-group" required="true" label="Stateroom Location Preference" inline="true" name="stateroom-location-preference"> <option label="Aft - Located at the back of the ship" value="aft-located-at-the-back-of-the-ship">Aft - Located at the back of the ship</option> <option label="Midship - Located in the middle of the ship" value="midship-located-in-the-middle-of-the-ship">Midship - Located in the middle of the ship</option> <option label="Forward - Located in the front of the ship" value="forward-located-in-the-front-of-the-ship">Forward - Located in the front of the ship</option> </field> <field type="radio-group" required="true" label="Deck Location Preference" description="NOTE: Not all Stateroom categories are located on all Decks. We will do our best to place to select a Stateroom on or close to the Deck you select." inline="true" name="deck-location-preference"> <option label="Upper Deck" value="upper-deck">Upper Deck</option> <option label="Lower Deck" value="lower-deck">Lower Deck</option> <option label="No preference" value="no-preference">No preference</option> </field> <field type="radio-group" required="true" label="Do you need an Accessible Stateroom?" inline="true" name="do-you-need-an-accessible-stateroom"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h1" label="Additional Information"/> <field type="radio-group" required="true" label="Have you sailed with Disney Cruise Line?" name="is-this-your-first-cruise"> <option label="Yes - I am a Silver Castaway Club Member (1 - 4 Cruises)" value="yes-i-am-a-silver-castaway-club-member-1-4-cruises">Yes - I am a Silver Castaway Club Member (1 - 4 Cruises)</option> <option label="Yes - I am a Gold Castaway Club Member (5 - 9 Cruises)" value="yes-i-am-a-gold-castaway-club-member-5-9-cruises">Yes - I am a Gold Castaway Club Member (5 - 9 Cruises)</option> <option label="Yes - I am a Platinum Castaway Club Member (10 -2 4 Cruises)" value="yes-i-am-a-platinum-castaway-club-member-10-2-4-cruises">Yes - I am a Platinum Castaway Club Member (10 -2 4 Cruises)</option> <option label="Yes - I am a Pearl Castaway Club Member (25 or more Cruises)" value="yes-i-am-a-pearl-castaway-club-member-25-or-more-cruises">Yes - I am a Pearl Castaway Club Member (25 or more Cruises)</option> <option label="No - This will be be my first Disney Cruise" value="no-this-will-be-be-my-first-disney-cruise">No - This will be be my first Disney Cruise</option> </field> <field type="checkbox-group" required="true" label="Are you celebrating something special during this Cruise?" inline="true" name="are-you-celebrating-something-special-during-this-cruise" other="true"> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Birthday" value="birthday">Birthday</option> <option label="Graduation" value="graduation">Graduation</option> <option label="Holiday" value="holiday">Holiday</option> <option label="Retirement" value="retirement">Retirement</option> <option label="None of the above" value="none-of-the-above">None of the above</option> </field> <field type="radio-group" required="true" label="Select your preferred dining time" inline="true" name="select-your-preferred-dining-time"> <option label="Main Seating (5:45 pm)" value="main-seating-545-pm">Main Seating (5:45 pm)</option> <option label="Second Seating (8:15 pm)" value="second-seating-815-pm">Second Seating (8:15 pm)</option> <option label="No preference" value="no-preference">No preference</option> </field> <field type="text" label="List the names of family or friends who are also sailing on this Cruise" description="We will try to book your Stateroom near family or friends whenever possible." name="list-the-names-of-family-or-friends-who-are-also-sailing-on-this-cruise" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Is anyone in your party pregnant or planning to become pregnant before the cruise?&nbsp;" description="So that we can advise as each cruise line has its own pregnancy policy. All information is private." inline="true" name="is-anyone-in-your-party-pregnant-or-planning-to-become-pregnant-before-the-cruise-"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="textarea" required="true" label="Are there any medical or dietary needs/preferences ?&nbsp;" description="If not enter "No"" name="what-else-would-you-like-me-to-know-do-you-have-any-medical-or-dietary-needspreferences-does-anyone-in-your-party-have-mobility-issues-i-should-be-aware-of" className="form-control"/> <field type="textarea" required="true" label="Does anyone in your party have mobility issues we should be aware of?" description="If not enter "No"" name="does-anyone-in-your-party-have-mobility-issues-we-should-be-aware-of" className="form-control"/> <field type="header" subtype="h1" label="Pre and/or Post-Cruise Stay"/> <field type="paragraph" subtype="p" label="We strongly recommend that our clients arrive in the Cruise departure city at least one day prior to sailing.&nbsp; We can assist you with booking a Pre-Cruise hotel stay, a Post-Cruise hotel stay or both."/> <field type="checkbox-group" required="true" label="Would you like assistance with booking a Pre/Post-Cruise hotel stay?" description="Check all that apply" name="would-you-like-assistance-with-booking-a-prepostcruise-hotel-stay"> <option label="Yes - I would like to discuss a Pre/Post Cruise stay at Walt Disney World" value="yes-i-would-like-to-discuss-a-prepost-cruise-stay-at-walt-disney-world">Yes - I would like to discuss a Pre/Post Cruise stay at Walt Disney World</option> <option label="Yes - I would like to discuss a Pre/Post Cruise stay off-site" value="yes-i-would-like-to-discuss-a-prepost-cruise-stay-offsite">Yes - I would like to discuss a Pre/Post Cruise stay off-site</option> <option label="No - I plan to fly in the day of the Cruise" value="no-i-plan-to-fly-in-the-day-of-the-cruise">No - I plan to fly in the day of the Cruise</option> </field> </fields> </form-template> </body> </html>
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