Adventure Tourist Medical Information Declaration Form
Full Name
Date of Birth
Gender
Male
Female
Other
Prefer not to say
Passport Number
Nationality
Emergency Contact Name & Relationship
Emergency Contact Phone
Do you have any existing medical conditions or allergies?
Are you currently taking any medication(s)?
Describe your current level of physical fitness/recent training
Do you have any dietary restrictions or requirements?
Travel Insurance Provider & Policy Number
Declaration: I certify that the information provided above is true and complete to the best of my knowledge.
Signature
Date