Checking off your bucket-list, one trip at a time

ICELAND TRAVEL FORM

Personal Information

Name

First Name

Last Name

Birth date:

Age:

Country:

Cell Phone Number (with country code)

Emergency

Emergency Contact:

First Name

Last Name

Relationship:

Contact Number (including country code)

Do you have a valid Schengen Visa?

If you do not require a Schengen Visa, please check YES

YES

Departure Information

Date of Departure from Keflavik Airport

YYYY

Time of Departure from Keflavik Airport

(please include a.m. or p.m.)

Flight Number

Fitness and Medical History

What is your physical fitness level?

How often do you exercise and what type of sport you like to practice?

Please list previous medical/psychological conditions which may affect your fitness level

Do you have any heart related conditions?

Please list any medications you are taking

Please provide any additional information that may be useful to emergency medical personnel in the event of an emergency

ICELAND 1 FORM