Registration Form - Getaway Trekking & Adventures

Step 1 of 5 - Personal Information

20%

Your Personal Information

Name(Required)

Title First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Gender(Required)

Date of birth(Required)

DD slash MM slash YYYY

Trekking Shirt Size(Required)

Emergency Contact

Emergency Name(Required)

First Last

Emergency Phone(Required)

Emergency Email(Required)

Your Passport Information

I am in possession of a current Passport with at least 6 months validity from my estimated date of departure(Required)

Yes

N/A - domestic

Hidden

Please provide a brief explanation on the status of your Passport

Passport Number

Passport Nationality

Name as per passport

Passport Date of Issue

DD slash MM slash YYYY

Passport Expiry

DD slash MM slash YYYY

Copy of Passport

Max. file size: 128 MB.

If you have a scanned copy of your passport available, please upload it here. Alternatively, please email a copy to info@getawaytrekking.com

Your Medical Information

Hidden

Please indicate your COVID-19 vaccine status:

Hidden

Getaway Trekking is required by the Public Health Directives of the relevant State or Territory to ensure all patrons participating in group tours are fully vaccinated. If you have an exemption or are in the process of being vaccinated, please provide details below:

Height (cm)(Required)

Weight (kg)(Required)

Are you currently suffering from a medical condition?

Yes

Please provide further information

Are you currently prescribed any medication?(Required)

Yes

Please provide further information

Do you regularly participate in any any physically active sport/activity?(Required)

Yes

Please provide further information

Sport Type

Walking

Cardio

Strength and Conditioning

Team Sports

Frequency

Please indicate whether you have ever experienced (at any stage of life) any of the following medical conditions...

Reactions to drugs and/or medicines(Required)

Yes

Any major joint and/or back injuries(Required)

Yes

Any allergies(Required)

Yes

Please provide further information

Are there any other items related to your health that your trek leader should be aware of?(Required)

Yes

Please provide further information

Do you have any dietary requirements?(Required)

Yes

Please provide additional information related to any dietary requirements

Hidden

Flights

Please contact me regarding Flights / Travel Arrangements

I have organised my own Flights / Travel Arrangements

Hidden

Payment Method

Please contact me regarding my deposit

I have already paid my deposit

Final balance paid

FOC

Terms and Conditions(Required)

I have read and agree to the Booking Terms and Conditions

Health Information(Required)

I have honestly and accurately disclosed my health information and I am fit and able to participate in the trek

Please keep me informed of new specials and trek-related info from time-to-time

How did you hear about us?(Required)

Electronic Signature

Please type your name

Your Personal Information

Emergency Contact

Your Passport Information

Your Medical Information

Proceed Booking

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