Holiday destination

Date of arrival in the holiday destination 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December

Kind of accomodation requested Single occupancy Double occupancy

If double, please indicate the name of your partner

Title Mr Mrs Miss Ms Dr

Name

Gender Male Female

Address

Town

Post code

Country

Home telephone number

Mobile

Email address

Date of birth

Medical condition

Do you suffer from any heart condition? Yes No

Have you any joints or muscles problems or any disease which could affect your ability to walk? Yes No

Do you have any allergies? Yes No

Are you under any medication? Yes No

Please specify

Please let us know if you have any
particular dietary requirements

If you have any doubts about your fitness or your ability to join the holiday please seek medical advice.

Please give details of the person to contact in case of emergency:

Name

Address

Town

Post code

Country

Home telephone number

Mobile

Email address

It is important that you have a Travel Insurance which properly covers your participation in whatever activities you may undertake during your walkwithin holiday. If you already have Travel Insurance please give indication of your Insurers and Policy number below:

Insurer details

Policy number

If you do not have Travel Insurance, please make sure you purchase satisfactory insurance cover. By signing this form you give confirmation of having a proper Travel Insurance in place for the duration of your walkwithin holiday.

I have read and accepted walkwithin Terms of business as part of this booking. I agree to all the conditions.