Emergency Medical Consent Form Please fill out this form prior to travel with us to provide emergency medical consent. Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Tour Destination * Flying Into * Arrival Date * MM DD YYYY Arrival Time * Hour Minute Second AM PM Departure Date * MM DD YYYY Departure Time * Hour Minute Second AM PM Flying From * Flight Number #1 * Flight Number #2, if applicable (connecting flight) * Passport Number * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name * Emergency Contact Phone Number * Relationship to Emergency Contact * First Name Last Name Do you have any existing medical conditions or allergies? * Yes No If yes, please provide details: Are you currently taking any medications? * Yes No If yes, please provide details: Do you have any specific medical instructions or preferences? * Please list any food allergies/intolerances * By Checking this box, you certify this information to be true and that you are fit to travel with us! * Yes Thank you!
