Client Travel Form

CLIENT TRAVEL FORM

This form is designed to make it easier to supply information that may affect your participation in any of our The Urban Birder Tours to ensure that you have a trouble free and enjoyable tour with us.

If you would prefer to complete the form manually, download the tour booking form here. Once completed, please return this document by email to tours@theurbanbirderworld.com at your earliest convenience.

This form is only to be filled by The Urban Birder World customers. You will need to submit one form for each member of the tour.

THIS IS REQUIRED TO COMPLETE YOUR RESERVATION.

Please, complete all fields *.

PASSPORT DETAILS

Please, block capitals as shown in Passport.

*Surname

*Forename

*Title

*Sex

*Date of birth

*Nationality

*Passport number

*Place of issue

*Date of issue

*Date of expiry

NEXT OF KIN DETAILS / EMERGENCY CONTACT

*Full Name

*Relationship

*Emergency Contact Phone Number

*Emergency Contact Email

FLIGHT DETAILS

Please provide us with your flight details. (If you do not have the information yet, please write N/A instead.)

Outbound

*Departure Airport

*Arrival Airport

*Date

*Airline and Flight number

*Arrival Time

Inbound

*Departure Airport

*Arrival Airport

*Date

*Airline and Flight number

*Departure Time

MEDICAL RECORD

In the event of a medical problem the information you give below could be vital for your health and safety. The information is supplied in confidence and will be kept confidential. In certain situations, we may be required to use the information to consult with a doctor, hospital or medical centre providing help or advice. This may be done in an emergency or with your express permission.

*During the last five years, have you suffered any significant illness, or been in hospital, or needed regular care by a doctor?

Examples could include asthma, tuberculosis, chronic bronchitis, emphysema or any other lung complaint; high blood pressure, rheumatic fever heart complaints; gout, arthritis, back, leg or foot trouble; gastric or duodenal ulcer, colitis or intestinal trouble; epilepsy or fits of any kind; depression, anxiety state or mental disorder; kidney or bladder disease.

*Have you had any other illness, injury, operation or treatment likely to affect your ability to complete your holiday successfully? If so, please note any details.

*Have you had any allergies, or reactions to drugs?

We recommend that that anyone on medication or with a medical allergy (e.g. antibiotics) takes full details on holiday, written so it can be read by a foreign pharmacist.

*Do you take any medication regularly? If so, please record them here, including quantities.

*Have you checked that your holiday insurance takes into account your medical history? Please note anything relevant along with insurance details.

*Do you have any specific dietary requirements? Include allergies as well as particular dislikes or other special requests.

*I declare that the answers to the above are true and complete and that I expect to be able to complete the holiday without serious problems.

*I agree to this information being available to the leader accompanying the party, and if need be to a doctor, hospital or medical centre providing help or advice.

*I further understand that I have sole responsibility for ensuring that our passports are valid for at least 6 months beyond the date of our return and for obtaining all necessary visas unless specifically agreed otherwise.

Signed:

*Your Full Name

*Your Email

*Mobile

*Date

I agree to the terms and conditions laid out in the Privacy Policy

The Urban Birder is committed to using the data collected through this form only to manage your query. Also, you give us the consent to be able to respond to your message through email. Your information will remain confidential and secure. View our Privacy Policy for more information.

Please leave this field empty.

Thank you and have a great holiday!