Backpack Travel Tracking

This form is used by Backpack members who wish to identify travel plans while away on study abroad / exchange.

Name * First Last
Student ID *
Phone Number * - ### - ### ####
Email Address *
School *
Destination Details
Primary Destination *

This is the destination where you will primarily be studying, working, living, etc.
Secondary Destination

Please indicate the location you plan to travel to outside of your primary destination. I.e. weekend trips to a neighbouring city or country.
Date of Departure * / MM / DD YYYY

This is the date of departure from your primary destination.
Date of Return / MM / DD YYYY

This is the date of return to your primary destination.
Tertiary Destination

Please indicate the location you plan to travel to outside of your primary destination. I.e. weekend trips to a neighbouring city or country.
Date of Departure / MM / DD YYYY

This is the date of departure from your primary destination.
Date of Return
/ MM / DD YYYY

This is the date of return to your primary destination.
Are you travelling with a companion? *
Yes No
Companion Details

If you are travelling with a companion, please fill out the following fields.
Name First Last
Phone Number - ### - ### ####
Email Address
In the event of an emergency, do you consent for Backpack to contact your travel companion, or share this information with designated authorities ?
Yes No
Emergency Contact Information

This information will only be used in the event of an emergency such as medical, environmental, travel, etc.
Name * First Last
Phone Number * - ### - ### ####
Email Address *
Relation to You *
In the event of an emergency, do you consent for Backpack to contact your emergency contact, or share this information with designated authorities ? *
Yes No
Additional Details
Are there any other details you wish to provide while travelling abroad? Such as additional locations of travel, medical information,
I acknowledge that the information contained in this form may be used to assist me during an emergency. This includes but not limited to liaising with my primary and or host university, the insurance provider, local emergency services, embassy or consulate services.

CASL AUTHORIZATION: I have read, understand and consent to receive communications from Backpack or it's affiliates by e-mail for the purpose of administering my coverage and or assistance. If you wish to no longer receive communications by e-mail please e-mail backpack@studentvip.ca. *

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Backpack Travel Tracking

Backpack Travel Tracking

Destination Details

Companion Details

Emergency Contact Information

Additional Details