Pre-Departure Booking Form and Questionnaire

Endeavour Safaris
Please fill in this form to forward a booking enquiry on to us.
Information you give us here will enable us to advise you better on the safaris you would like to take, and to help with questionnaires relating to internal airline travel.

General Section

First Name

Last Name

Phone/Mobile/Cell Number

Country

Skype Name

Email Address

Date of Arrival

Number of Adults in Party

Number of Children in Party

Passport(s) (must have 6 months before expiry)

What tour/safari would you like to do?

For the Disabled or Senior Traveller

Where would you place yourself?

Mobility Impairment

Hearing Impairment

Vision Impairment

Kidney Dialysis

Oxygen Dependent

Senior

Other (please explain)

Mobility on safari

Can walk

Can walk with difficulty

Uses walking frame, crutches, or cane(s)

Uses manual wheelchair

Uses electric wheelchair

Uses electric scooter

Other (please explain)

Do you travel with a carer or similar companion?

If walking is difficult, what is the distance in metres you can walk?

Width of wheelchair or scooter in cm?

Height of wheelchair seat in cm?

Bathroom

Do you require oxygen in-flight?

No

Yes

Do you experience epileptic attacks?

No

Yes

Do you require medication other than self-administered?

No

Yes

Do you require a seat in the shower?

No

Yes

Transfers

Do you sit in a normal vehicle seat while travelling?

No

Yes

Do you need help to eat?

No

Yes

Do you have any special dietary requirements?

No

Yes

Are you or any member of your party a vegetarian?

No

Yes

Sharing rooms

Weight in kilograms (if lifting etc. may be required)

Final Section

Vaccinations

Doctor's Name

Doctor's Contact Number

Further information, questions, or requirements

Please attach any document you may feel is required in addition to the information already given.

Please email me updates

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