Cruise Passenger Medical Information Declaration Form

Passenger Information

Full Name Date of Birth Gender Female Male Other Passport Number Cabin Number Emergency Contact Name Emergency Contact Phone

Medical Conditions

Do you have any existing medical conditions? If yes, please specify Do you require special assistance? If yes, please specify

Allergies & Medications

Please list any allergies Please list any current medications

Further Information

Special dietary requirements Other relevant medical information

I declare that the information provided is true and complete to the best of my knowledge.