TravelJoy

Rosie Dietrich

Dietrich Getaways

Dominican Republic 2027

Feb 13, 2027 to Feb 20, 2027

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	<fields>&#13;
		<field type="header" subtype="h1" label="BOOKING FORM"/>&#13;
		<field type="paragraph" subtype="p" label="Complete By March 6th"/>&#13;
		<field type="paragraph" subtype="p" label="Completing this form does not guarantee a reservation.&amp;nbsp; This allows us to place a hold on the room category of your choice at the hotel, and holds your seat on the plane.&amp;nbsp; &amp;nbsp;Deposit of $150/ person will be required by May 26, 2026."/>&#13;
		<field type="paragraph" subtype="p" label="Upon form submission, we will send you a passport information form and credit card authorization form required to reserve your room with deposit by May 26th."/>&#13;
		<field type="header" subtype="h1" label="Lead Passenger / Payer Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred&amp;nbsp; name (if different from documents)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Room Information"/>&#13;
		<field type="radio-group" required="true" label="Room Categories" name="room-category-choose-one">&#13;
			<option label="Family Junior Suite Premium Level" value="family-junior-suite-premium-level">Family Junior Suite Premium Level</option>&#13;
			<option label="Junior Suite Ocean Front Premium Level" value="junior-suite-ocean-front-premium-level">Junior Suite Ocean Front Premium Level</option>&#13;
			<option label="Suite Ocean Front Premium Level" value="suite-ocean-front-premium-level">Suite Ocean Front Premium Level</option>&#13;
			<option label="Standard Family Room" value="standard-family-room">Standard Family Room</option>&#13;
			<option label="Standard Junior Suite" value="standard-junior-suite">Standard Junior Suite</option>&#13;
			<option label="Standard Superior Room" value="standard-superior-room">Standard Superior Room</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many adults (12+)?" name="how-many-adults-18" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children under 2?" name="text-1771433753060" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children (2 - 11 at time of trave)?" name="how-many-children-2-12-at-time-of-trave" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Insurance Options&amp;nbsp;" name="insurance-options">&#13;
			<option label="Please quote options (No obligation to purchase)" value="please-quote-options-no-obligation-to-purchase">Please quote options (No obligation to purchase)</option>&#13;
			<option label="Decline all insurance" value="decline-all-insurance">Decline all insurance</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="Additional Information (Optional)"/>&#13;
		<field type="textarea" label="Do you have any dietary restrictions or food allergies?" name="dietary-restrictions" className="form-control"/>&#13;
		<field type="textarea" label="Do you have any medical conditions we need to be aware of?" name="medical-conditions" className="form-control"/>&#13;
		<field type="textarea" label="Anything else you think we should know?&amp;nbsp;" name="additional-notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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