Your Name (Mandatory): Email (Mandatory): Contact Number: Safari That You Booked? (Mandatory) MEDICAL REQUIREMENTS ====================== If you have any medical requirements, including significant allergies, choose the applicable ones from the options below. We will inform the property prior to your trip to cater for, and assist you accordingly. B. Allergies ========= If you have any of the allergies listed below, choose "Yes". Bees: NoYes Milk: NoYes Shellfish: NoYes Eggs: NoYes Peanuts: NoYes Soy: NoYes Gluten: NoYes Penicillin: NoYes Wheat: NoYes Lactose Intolerant: NoYes Pork: NoYes Other Allergies? C. Medical Conditions ================= If you have any of the medical conditions listed below, choose "Yes". Back Problems: NoYes Disability: NoYes Oxygen Machine NoYes Pacemaker: NoYes Sleep Apnea: NoYes Low Blood Pressure: NoYes Wheel Chair: NoYes Diabetes: NoYes Pregnant: NoYes Other Medical Conditions? D. DIETERY PREFERENCE ===================== Most dietary preferences can be catered for. Please advise us of any specific dietary requirements and these will be communicated to all the properties you will be visiting. Gluten Free: NoYes Halaal: NoYes Kosher: NoYes Pescetarian: NoYes Vegan: NoYes Vegetarian: NoYes Drinks Preference: E. SPECIAL OCCASION ================== If you are celebrating a special occasion, please tell us about it and we will do our best to make it extraordinary. Birthday: NoYes Wedding Anniversary: NoYes Honeymoon: NoYes Other (please specify) F. TRAVEL DETAILS ================ Please advise your travel details below. International arrival flight: International departure flight: G. PASSPORT DETAILS =================== Please take note - It is a mandatory requirement that you travel to Africa with at least two consecutive blank passport pages, per country visit. Full name as per passport Date of Birth Passport Nationality Country of Residence Passport Issue Date Passport Expiry Date Passport Number H. NEXT OF KIN ============= Please give us your next of kin that we can reach out to should the need arise Next of Kin Name His/Her Mobile Number (Include Country Code Please) I. SPECIAL REQUEST ================= If you have any other special requests, do mention them in the text box below J. AGREEMENT ============ By clicking on the "Submit Details" button below you are agreeing to our Terms & Conditions. Choose "Yes" if you agree. Yes
