Full Name *

Date of Birth *

Passport number *

Nationality *

Telephone *

Telephone

E-Mail *

Postal Code

Address

District

City

Province

Country

Blood Type

Do you have life insurance? Wich one?

Do you have any dietary restrictions? (vegetarian, vegan, allergies, etc.)

Can you swim?

Do you take any regular medication? Which?

Do you have any allergies or respiratory problems? Which?

Do you smoke?

Do you drink alcohol?

Do you practice sports? Which? Frequency?

Are you aware and in agreement with the risks involved in the activity that you are acquiring? *Are you aware and in agreement with the risks involved in the activity that you are acquiring?*YES I AM AWARE AND IN AGREEMENTNO I AM NOT AWARENO I AM NOT IN AGREEMENT

Emergency contact name

Emergency contact phone