Name*

First

Last

Photo of person to be registered*

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Email*

Phone*

Age*

Gender*

Height and weight

Sexual orientation

Would you like us to arrange any of these services for you?*

Yes

No

Please select*

Do you have a will?

Do you have an attorney?

Do yopu have a trust?

Do you have a power of attorney?

Select your accommodations *

Select living arrangemens*

Medical Information

Medical personel will be present at all group events

Do you have any medical condition we need to know about*

Yes

No

We use an (EMR) electronic medical records program to make sure that we understand you medical conditions. Will you consent to the use of our program while in or care.*

Yes

No

By not consenting to the use of our EMR program, you are solely responsible for all health problems while you are on your vacation with us.

Do you have a physician*

Yes

No

Name of physician and contact number*

Physician Adderess*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Date of Birth*

day

/

month

/

year

Height and Weight*

Person to contact in case of emergency, relationship and phone#*

Send a copy of this message to yourself*

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