Passenger Information | Jane's Journeys

Passenger Information Form

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone Number (Mobile or Landline)(Required)

Date(Required)

Birthdate(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Tour You Are Interested in Booking(Required)

I Am Paying:(Required)

Deposit

In Full

Other

Doctor's Name(Required)

First Last

Doctor's Phone Number(Required)

Medications (list by brand name; include dosage if possible)(Required)

Allergies (Example: Medications or Foods)(Required)

Emergency Contact(Required)

First Last

Relationship to Passenger(Required)

Emergency Contact's Phone Number(Required)

Please list all health conditions we should know about.(Required)

I Have Had the Covid-19 Vaccination.(Required)

Yes

Are you celebrating a special occasion on this tour? (Example: Birthday, Anniversary, etc.) Let us know!(Required)

Enter your full name below to indicate the following: I understand that Jane’s Journeys, LLC, as a tour operator, does not assume and cannot be held liable for personal illness, such as Covid-19 or personal injury, property damage or other loss that may occur as a result of negligent acts or omissions on the part of any supplier.(Required)

First Middle Last

Comments

This field is for validation purposes and should be left unchanged.

You can download a copy of Jane’s Journeys LLC Passenger Information Form here.