Registration Form

Please fill out the details below to complete your registration.

Trip Name and Date

First Name

Last Name

Nationality

Passport Number

Occupation

Birth Date

Weight

Height

Phone

Email

Emergency Contact Name

Emergency Contact Phone

Allergic to Any Medicine

Yes

No

Allergic to Insect Bites

Yes

No

Allergic to Any Food

Yes

No

Physical Disablement Details

Do You Swim

Yes

No

Fitness Level

Daily training

Eventual training

No training at all

I accept the terms and conditions and the liability release for this adventure travel tour.

I hereby release Akanan Amazing Adventures, its employees and any of its agents from any liability resulting from accident(s) from my participation in the activity which I am undergoing with them. I declare that such activities I am performing under my own responsibility and with the absolute knowledge of the risk(s) involved.

Signature

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Date