Guest Registration Form printable pdf download

Guest Registration Form

O.A.R.S. GRAND CANYON GUEST REGISTRATION FORM

Tour Code: ___________________

Please take a few minutes to complete both sides and pages of this form

along with the Visitor’s Acknowledgement of Risk Form and return to

Booking #: ___________________

O.A.R.S. Grand Canyon, Inc., P.O. Box 67, Angels Camp, CA 95222 as soon

as possible to ensure that we provide you with the best vacation possible.

Legal Name (First) _______________________ (Last) _________________________ Preferred Name ______________

Address___________________________________________City___________________State______ Zip____________

Phone (Hm) _________________________ (Wk) ___________________________ Cell _________________________

Email _________________________________________ Birth Date ______________________ Age______________

Height _____________ Weight* _____________ ( Needed to fit your personal flotation device)

Gender _________

*We reserve the right not to accept passengers weighing more than 260 lbs. or with a waist/chest size exceeding

56 inches. If you exceed these requirements, please give us a call.

Emergency Contact (DO NOT list yourself or someone on the trip):

Name: _____________________________ Phone:________________________ Cell Phone:______________________

MEDICAL/DIETARY INFORMATION - Please be specific.

Are you currently experiencing or have you ever had any of the following? If Yes, please explain. You

YES

may be required to provide a note from your doctor clearing you for the trip.

Heart problems/attacks:

Chest pain/pressure:

Frequent shortness of breath:

Frequent dizziness:

Frequent Fainting:

High blood pressure:

Depression/anxiety:

Smoker:

Hepatitis:

Seizures:

Overweight:

Currently Pregnant:

Asthma/respiratory problems:

Diabetes/blood sugar problems:

Recurrent/frequent headaches:

Ulcer/stomach problems:

Urinary tract problems:

Muscular-skeletal problems:

Major hospitalization/surgery (within the last year):

Allergies: Bee Stings & other severe allergic reactions

(If you are prone to anaphylactic shock, please bring an

epi kit-we do not carry them)

Other:

Over Please

Guest Registration Form

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