Booking form and health statement

Name

Gender

Address

Country

Telephone

Area CodePhone Number

Passport number

Issued

Date

Valid until

Date

E mail address

example@example.com

Date + place of birth

Date

Expeditions in 2026

Cabin preference

Special diet wishes

Emergency contact, names and tel.

Area CodePhone Number

I declare to have a health insurance that covers the booked voyage

I declare to have travel insurance that covers the booked voyage

How do you know about us?

Other

I allow Tilvera Expeditions to print my/our tel. number on the passenger list, so that other passengers on this trip can contact me/us for a collective trip to the port of departure. (Please mark if you agree * delete as appropriate

I we, the undersigned declare to be familiar with the travel conditions of Tilvera Expeditions, to be found on our website: General Passenger Terms which apply to this contract. The undersigned is also responsible for the obligations of the fellow-travellers, mentioned in this form under this agreement.

Date

Signature

Tilvera Expeditions makes every effort to ensure the safety of every person on board. Our guests are expected as well to assume responsibility for their own safety. Insufficient mental or physical health may create undue risks not only to yourself, but it is essential to realize that illness or accidents may also threaten the safety of other guests and crew and may seriously disrupt the sailing program of the vessel.

If you are in doubt about your fitness for a sea voyage on a sailing and rolling ship you are requested to seek your doctor's advice first. To prevent misunderstandings please fill in and sign this document.

Do you use medication?

List your medicaments

Do you need help in climbing stairs or taking thresholds of 60 cm. ft)?

Are you by experience very prone to motion sickness (sea sickness)?

Do you have diabetes? If yes, do you need injections?

Do you have any respiratory problems? (e.g. asthma)

Do you have heart or circulatory problems?

Do you have epilepsy?

Do you have an increased risk for infections or did you have radio- or chemotherapy in the past 24

Name

Signature

Place

Date

By signing this Health Statement I declare to have answered these questions truthfully and that I am aware that I will participate in a voyage on the Tilvera at my own risk

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