Extreme Sports Tourist Medical Information Declaration Form
Personal Details
Full Name
Date of Birth
Passport Number
Nationality
Emergency Contact Number
Medical Information
Do you have any existing medical conditions?
Yes
No
If yes, please specify
Are you currently taking any medication?
Yes
No
If yes, please list medications
Do you have any allergies?
Yes
No
If yes, please specify
Have you had any recent surgeries or hospitalizations?
Yes
No
If yes, please provide details
Sports Activity Information
Type of Extreme Sport
Intended Dates of Activity
Level of Experience
Beginner
Intermediate
Advanced
Declaration
I hereby declare that the information provided is true and complete to the best of my knowledge.
Signature
Date