Emergency Contact Form

Emergency Contact Form
Name*

First NameMiddle NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*

Country CodeArea CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Date of Birth*

MonthDayYear
Date
Please state the purpose of your visit to the Sharklab?*
Confirmed Date of Arrival in Bimini*

MonthDayYear
Date
Confirmed Date of Departure from Bimini*

MonthDayYear
Date
Passport #*
Passport Expiration Date*

MonthDayYear
Date
Please upload a scanned copy of your passport*

Browse Files

Cancelof
Non-US/Bahamian residents: please upload a copy of your ESTA or US visa

Browse Files
Non-US/Bahamian residents: please upload a copy of your ESTA or US visa Cancelof
Nationality/Citizenship*
Insurance Details

Insurance details. All visitors are solely responsible for their health and any medical arrangements. Please provide details of your health and travel insurance below.
Body Weight*
This is required by our charter flight company to assess weight allowance on the plane.
Health Insurance Company*
Please provide us with all Health Insurance details
Company Phone Number (for emergency claims)*

Country CodeArea CodePhone Number
Policy Number*
Additional: insurance confirmation paperwork*

Browse Files
Please upload all insurance policy information Cancelof
Travel Insurance Company*
Company Phone Number*

Country CodeArea CodePhone Number
Policy Number*
Additional: insurance confirmation paperwork

Browse Files

Cancelof
Please confirm that any health care or medical assistance you may require in the Bahamas will be covered by your insurance company.*
Type YES to confirm
Please also confirm that your health/travel insurance will cover/organize any emergency evacuation off the island and does not require you to pre-pay and get reimbursed afterwards.*
Type YES to confirm
Health issues and dietary requirements

The health clinic on the island is very basic and often unreliable - therefore we advise you to bring sufficient medications for your entire stay. In terms of meals, please note that the Sharklab receives only one delivery of fresh produce per month. The team can not accommodate all eating habits - for example vegan and grain-free visitors may have to substitute their own food
Do you have any medical conditions we need to be aware of? Please provide as much detail as possible
Are you on any medications?
Please provide as much information as possible
Food preferences or allergies?
Please provide as much information as possible.
Emergency Contact

Please provide contact details of the person we should call in case of an emergency.
Name*

First NameLast Name
Relationship to yourself?*
Phone Number*

Country CodeArea CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Type a question
Should be Empty:

Emergency Contact Form

Insurance Details

Health issues and dietary requirements

Emergency Contact