Eco-Tourism Volunteer Trip Health Declaration Form

Personal Information

Full Name Date of Birth Email Address Phone Number Emergency Contact Name Emergency Contact Phone

Medical Information

Do you have any existing medical conditions? Allergies Are you currently taking any medications? Have you had any recent illnesses, injuries, or surgeries? Are all vaccinations up-to-date? Yes No

Fitness for Travel

Are you able and fit to participate in physical activities? Yes No Dietary Restrictions

Declaration & Consent

I declare that the information provided is true and complete. Signature Date