Booking form and health statement

Name*
FemaleMaleOther
Address*
Country*
Telephone

Area CodePhone Number
Passport number*
Issued

MonthDayYear
Date
Valid until

MonthDayYear
Date
E mail address*
example@example.com
Date + place of birth*

MonthDayYear
Date
1 Iceland - Jan Mayen - Svalbard: Sail Training & Whale Research6 North Svalbard: Wildlife Reconnect7 North Svalbard - Húsavík (Iceland): Along the Ice Edge8 Iceland Hope Expedition - Ocean Missions
Shared cabin with private shower and toiletShared cabin without private shower and toiletSingle supplement for one person in a private cabin (+70% / journey)
Special diet wishes*
Emergency contact, names and tel.

Area CodePhone Number
YesNo
YesNo
Social media (Fb, Instagram...)A friend or people that I knowI have already sailed this boat before 2023 with Heinz WutschkeI follow Belén and Heimir adventures with Ocean MissionsThrough North SailingOur websiteOther
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

MonthDayYear
Date
Signature

Clear
Health Statement
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.
YesNo
List your medicaments
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Name
Signature

Clear
Place
Date

MonthDayYear
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
YesNo
Should be Empty:

Health Statement