Kwazulu-Natal Marine Educational Tour booking page

Your Details

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

Name and Surname

Date of birth

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Nationality

Passport number

Passport expiry date

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Gender

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Contact details

Contact number

Whatsapp number

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Email address

Natural parent name and surname

Natural parent contact number

Natural parent email address

Host parent name and surname

Host parent contact number

Host parent email address

Physical address

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T-shirt details

Please select your T-shirt size and 2 colours. Option 1 is first choice, Option 2 is second choice.

Option 1 colour

Option 2 colour

T-shirt size

Dietary requirements

Dietary preference

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Food allergies

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Medical conditions and Insurance

Do you have any medical conditions to take note of?

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Are you allergic to anything?

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Medical aid or Insurance details

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

Acceptance

Terms and Conditions

Yes I accept (tick the box)

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/)

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