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

ICELAND AUGUST TRAVEL FORM

Personal Information

Name

First Name

Last Name

Birth date:

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

Arrival Information

Date of arrival to Keflavik Airport

YYYY

Time of arrival to Keflavik airport

Please add AM or PM

Flight number

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

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

I have read the full itinerary and I understand the nature of all the activities and the nature of the trip I have signed up for

I ACCEPT

ICELAND AUGUST 2024 FORM