Allergies Form WWWIA

Please complete the Health Information Travel Form to ensure your safety and well-being during our trips. Your health details allow us to provide appropriate support and accommodations as needed. Thank you for helping us make your travel experience enjoyable and worry-free.
Traveler's Name*
Emergency Contact Name*
Emergency Contact Relationship*
Emergency Contact Phone Number*
Do you have a WWIA membership*

YesNo
2025 Trips Traveling To: (Memberships only)

Bali Week 1 (April 8th-14th)Bali Week 2 (April 14th-18thTurks & Caicos (June 11th-17th)Peru (Sept 10th-15th)Thailand Tour (Nov 14th-21st)
For 2025 Trips (Couples Membership Only)

Bali (April 18th-23rd)Tulum (May 15th-19th)Gatlinburg (Sep 5th-9th)Saychelles (Oct 21st-27th)
Please list any known allergies
Food*
Medication*
Insect bites & stings*
Environmental*
Please list any current medical conditions*
Please list any medications you are currently taking (including dosage and frequency): *
Do you have any dietary restrictions*
Do you have any physical limitations*

YesNoOther
If, so, please list here
Please list any other health concerns we should be aware of*
I hereby certify that the information provided above is accurate and complete to the best of my knowledge.
Signature*

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Date*

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Date
Please Note: This form is for informational purposes only and should not be considered a substitute for professional medical advice. Always consult with a healthcare provider before traveling, especially if you have any health concerns.

It is recommended to carry a copy of this form with you while traveling, along with any necessary medications and medical documentation. Research the healthcare facilities available at your destination in case of an emergency. Consider purchasing travel insurance that covers medical expenses. Familiarize yourself with any health risks or outbreaks at your destination.
Should be Empty:

Please list any known allergies