Terra Expeditions AB

HEALTH DECLARATION FORM

It is important that we know that everyone that travels with us is in good health, but it is even more important for us to know if our guests have any allergies or are taking any specific medication that we might need to support them with in an emergency. Our expedition might take us far from the nearest hospital so the information that you provide here could be very important. Feel free to contact us by email or telephone if you wish to discuss this form further

All information given will be treated with the strictest confidence.

Verónica Rojas: +46705769988

veronica@vagabond-trails.com

If you are making the booking for more than one person or for someone else, kindly note that this form should be filled by each traveller themselves.

First name / Last name

Email Address

Birthday

Phone

IG handle

Emergency contact name, relationship and phone number (incl. international code)

Do you have any medical condition that could impact your ability to participate in the expedition that we should be aware of? If no, simply write "No".

Are you bringing any medicine that we should be aware of in case of an emergency? E.g. insulin, epinephrine, etc. If no, simply write "No".

Do you suffer from any allergies? E.g. from stings, bites, penicillin, elastoplasts, foods, etc. If yes, please list your allergies and also describe how you react to them. If no, simply write "No".

Do you have any injuries or are you prone to repetitive sports injuries? If yes, please describe the injuries. If no, simply write "No".

Do you have any particular dietary needs? E.g. vegetarian, celiac, etc? If no, simply write "No".

Are there any areas we have not yet covered that you feel may be relevant? If no, simply write "No".

I confirm that the information given in this form is true

Thanks! We have received your health declaration form.

Terra Expeditions AB

HEALTH DECLARATION FORM​

​

HEALTH DECLARATION FORM