<html> <body> <form-template xmlns="http://www.w3.org/1999/xhtml"> <fields> <field type="header" subtype="h2" label="Name &amp;amp; Contact Details"/> <field type="text" label="Prefix" class="form-control" name="prefix" subtype="text"/> <field type="text" required="true" label="First name" class="form-control" name="first-name" subtype="text"/> <field type="text" label="Middle name" class="form-control" name="middle-name" subtype="text"/> <field type="text" required="true" label="Last name" class="form-control" name="last-name" subtype="text"/> <field type="text" label="Preferred name" class="form-control" name="preferred-name" subtype="text"/> <field type="text" required="true" label="Phone number" class="form-control" name="phone-number" subtype="text"/> <field type="text" required="true" label="Email" class="form-control" name="email" subtype="text"/> <field type="header" subtype="h3" label="Passport Details"/> <field type="text" required="true" label="Full name as it appears on your passport" description="It is important that this matches your passport exactly." class="form-control" name="passport-name" subtype="text"/> <field type="date" required="true" label="Date of birth" class="form-control" name="birthday"/> <field type="text" required="true" label="Passport number" class="form-control" name="passport-number" subtype="text"/> <field type="date" required="true" label="Passport date of issue" class="form-control" name="passport-date-of-issue"/> <field type="date" required="true" label="Passport expiration" class="form-control" name="passport-date-of-expiration"/> <field type="text" required="true" label="Passport issuing country" description="Which country issued your passport" class="form-control" name="passport-country-of-issue" subtype="text"/> <field type="radio-group" required="true" label="Gender" name="gender"> <option label="F" value="f">F</option> <option label="M" value="m">M</option> <option label="X" value="x">X</option> </field> <field type="text" required="true" label="Place of birth" class="form-control" name="place-of-birth" subtype="text"/> <field type="text" required="true" label="Nationality" class="form-control" name="nationality" subtype="text"/> <field type="text" required="true" label="Citizenship" class="form-control" name="citizenship" subtype="text"/> <field type="file" label="Photo of passport ID page" class="form-control" name="passport_photo" subtype="file"/> <field type="text" label="TSA Secure Flight Program Information" class="form-control" name="tsa-secure-flight-program-information" subtype="text"/> <field type="header" subtype="h3" label="Covid-19 Vaccination Status"/> <field type="radio-group" required="true" label="Are you fully vaccinated against Covid-19?" name="are-you-fully-vaccinated-against-covid19"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="file" label="Vaccine card photo" class="form-control" name="vaccine_card_photo" subtype="file"/> <field type="header" subtype="h2" label="Address"/> <field type="text" required="true" label="Line 1" class="form-control" name="address-line-1" subtype="text"/> <field type="text" label="Line 2" class="form-control" name="address-line-2" subtype="text"/> <field type="text" required="true" label="City" class="form-control" name="address-city" subtype="text"/> <field type="text" required="true" label="State" class="form-control" name="address-state" subtype="text"/> <field type="text" required="true" label="Zip" class="form-control" name="address-zip" subtype="text"/> <field type="text" required="true" label="Country" class="form-control" name="address-country" subtype="text"/> <field type="header" subtype="h3" label="Emergency Contact Information"/> <field type="text" required="true" label="Emergency Contact Full name" class="form-control" name="emergency-contact-full-name" subtype="text"/> <field type="text" required="true" label="Emergency Contact Phone number" class="form-control" name="emergency-contact-phone-number" subtype="text"/> <field type="text" required="true" label="Relationship to you" class="form-control" name="emergency-contact-relationship" subtype="text"/> <field type="header" subtype="h3" label="Additional Information"/> <field type="textarea" required="true" label="Do you have any dietary restrictions or food allergies?&amp;nbsp;" class="form-control" name="dietary-restrictions"/> <field type="textarea" required="true" label="Do you have any medical conditions we need to be aware of?" class="form-control" name="medical-conditions"/> <field type="clientLoyaltyPrograms" label="Loyalty Programs" class="form-control" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***"/> <field type="textarea" required="true" label="What are the names of all parties traveling in your room? If traveling solo, please indicate solo.&amp;nbsp;" class="form-control" name="what-are-the-names-of-all-parties-traveling-in-your-room-if-traveling-solo-please-indicate-solo-"/> <field type="text" label="How did you hear about Texas Girl Travel? (Referred by, TicTok, Facebook, YouTube, FB Group etc)" class="form-control" name="how-did-you-hear-about-texas-girl-travel-referred-by-tictok-facebook-youtube-fb-group-etc" subtype="text"/> <field type="header" subtype="h3" label="Travel Insurance &amp;amp; Vacation Protection"/> <field type="paragraph" subtype="p" label="Texas Girl Travel strongly recommends that all travelers purchase travel insurance. By signing below, I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred. I, the undersigned, will not hold Texas Girl Travel and/or its agents responsible for any expenses incurred as a result of trip cancellation, accidents, sickness, stolen and/or damaged baggage.&amp;nbsp;"/> <field type="radio-group" required="true" label="Please indicate if you would like to purchase travel protection." name="please-indicate-if-you-would-like-to-purchase-travel-protection"> <option label="Yes, please provide a quote for travel insurance. Coverage will not apply until payment for insurance is received in full." value="yes-please-provide-a-quote-for-travel-insurance-coverage-will-not-apply-until-payment-for-insurance-is-received-in-full">Yes, please provide a quote for travel insurance. Coverage will not apply until payment for insurance is received in full.</option> <option label="No, I understand the financial risk and will complete the insurance waiver form that will be emailed to me." value="no-i-understand-the-financial-risk-and-will-complete-the-insurance-waiver-form-that-will-be-emailed-to-me">No, I understand the financial risk and will complete the insurance waiver form that will be emailed to me.</option> </field> <field type="text" required="true" label="Signature (First and Last Name)" class="form-control" name="signature-first-and-last-name" subtype="text"/> <field type="header" subtype="h3" label="Terms &amp;amp; Conditions and Privacy Policy"/> <field type="checkbox-group" required="true" label="Acceptance of Terms &amp;amp; Conditions and Privacy Policy" name="acceptance-of-terms-conditions-and-privacy-policy"> <option label="By submitting this form, I certify that I have reviewed and agree to the Deposit and Payment Terms listed on the group booking page and the Terms and Conditions and Privacy Policy of Texas Girl Travel found at www.texasgirltravel.com and that you can legally accept the terms on the traveler's behalf. I acknowledge that my electronic signature has the same legal validity as your manual signature." value="by-submitting-this-form-i-certify-that-i-have-reviewed-and-agree-to-the-deposit-and-payment-terms-listed-on-the-group-booking-page-and-the-terms-and-conditions-and-privacy-policy-of-texas-girl-travel-found-at-wwwtexasgirltravelcom-and-that-you-can-legally-accept-the-terms-on-the-travelers-behalf-i-acknowledge-that-my-electronic-signature-has-the-same-legal-validity-as-your-manual-signature">By submitting this form, I certify that I have reviewed and agree to the Deposit and Payment Terms listed on the group booking page and the Terms and Conditions and Privacy Policy of Texas Girl Travel found at www.texasgirltravel.com and that you can legally accept the terms on the traveler's behalf. I acknowledge that my electronic signature has the same legal validity as your manual signature.</option> </field> <field type="text" required="true" label="Signature (First and Last Name)" class="form-control" name="signature-first-and-last-name" subtype="text"/> </fields> </form-template> </body> </html>
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