Please complete the form below after reading our Terms & Conditions to register for your trip. Thank you!

guest information

 

emergency contact information

 

Insurance

Comprehensive insurance should be purchased before traveling to Africa. Travel Insurance should at least cover personal accident, medical expenses, hospitalisation, repatriation, trip curtailment, cancellation, and loss of valuables.

 

allergy information

 

medical information

 

other medical information

 

heart risk assessment

 

activity log

Any of our trips involving hiking, mountain biking or other strenuous activity requires that participants be reasonably fit. Please indicate below regularly performed exercise activities.

 

arrival information

 

departure information

 

preferences

 

terms & conditions

 
Name *
Name
Address *
Address
Emergency Contact Name *
Emergency Contact Name
Do you have any allergies? *
Please complete the section below if you have any allergies
Are you taking any medication? *
Please complete the section below if you are taking any medication
Seizure in the last 2 years *
History of heart attack/bypass or rhythm abnormality *
Hospitalisation/visited A&E in the last 2 years *
Medical device (hearing aid/prosthetic device) *
Orthopaedic problem (neck, back, ankle, or knee) *
Currently pregnant *
Organ removed *
Diabetic requiring medication *
Diagnosed high blood pressure *
Smoker *
Family history of heart attack/bypass or sudden unexplained death before 60 *
Unexplained chest pain, shortness of breath, heart palpitations, sweats *
Abnormally high cholesterol level *
Fainting spells, dizziness *
Confirm if AM or PM
Confirm if AM or PM
Dietary Preferences:
I have read and fully understand the Terms & Conditions *