Reservation form - Bushward

Bushward Safaris Reservation form

Your Details

Please complete the form below and press "send form" at the end. Please note that all entries marked with " * " is required.

Tour Name

Please enter the tour name that you are going on

Name and Surname

Date of birth

Please type in the date (yyyy-mm-dd)

Nationality

Passport number

Passport expiry date

Please type in the date (yyyy-mm-dd)

Gender

Female Male

Occupation

Sharing partner name

Please enter the name of the person sharing accommodation with you

Accommodation type

Single

Twin (Two single beds)

Double (Double bed)

Please select accommodation type required

Contact details

Contact number

Email address

Next of Kin

Next of Kin contact number

Dietary requirements

Dietary preference

Please indicate if you have any dietary requirements - write "none" if not applicable

Food allergies

Please indicate if you have any food allergies - write "none" if not applicable

Medical conditions and Insurance

Do you have any medical conditions to take note of?

Please indicate if you have any medical conditions? - write "none" if not applicable

Are you allergic to anything?

Please indicate if you allergic to anything? - write "none" if not applicable

Medical aid or Insurance details

Travel Insurance details, Insurance company, Policy number, Contact number/ Medical aid details

Vehicle details

Vehicle make and model

Please enter the vehicle make and model if you are taking your own vehicle on the tour

Vehicle registration number

Please enter the vehicle registration number

Vehicle colour

Please enter your vehicle colour

Are you taking a trailer on tour?

Yes No

Trailer registration number

If marked "Yes", Please enter the trailer registration number

Number of people in the vehicle?

How many people will be with you in the vehicle?

Acceptance

I accept the terms and conditions I do not accept the terms and conditions I have read and fully understand the conditions and general information as set out by Bushward Safaris. I acknowledge that it is entirely my responsibility to ensure that I am adequately insured for the above venture. I furthermore indemnify Bushward Safaris, their staff, management and affiliates from any liability whatsoever, and realise that I undertake the above venture entirely at my own risk. (https://bushward.co.za/information/terms-and-conditions/)

How can we help?

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Comments / Questions