Passenger Information & Medical Form

1. Your full name

2. Name of Lead Customer (if part of group booking)

3. Voyage

5. Date of birth:

   1. Day (1 - 31)*

   2. Month (1-12)*

   3. Year*

6. Does your sailing location require you to have a passport?*—Please choose an option—YesNo

   1. Passport number*

   2. Passport expiry date*

   3. Place of birth, exactly as it appears on your passport*

   4. Country of issue*

   5. Passport issue date*

1. Contact name*

2. Contact telephone number*

3. Contact email address*

4. Contact's relationship to you*

The sea is a natural and unpredictable environment and there are some medical conditions that, even if ‘under control’ on dry land, could become critical at sea and threaten the safety of the individual. If you answer “Yes” to any questions in Section 1 we may contact you for further information, regrettably in some instances we may not able to accept your booking on certain vessels or voyages. Whilst we want our holidays to be open for everyone, we do need guests to meet certain mobility and access requirements.Please do discuss with the team if you have any questions or concerns.

1. Would you have difficulty climbing a vertical two metre ladder or using small boat/dinghy on a daily basis while at sea? This is a vital part of our sailing requirements to ensure guest safety and your holiday experience.*—Please choose an option—YesNo

2. Are you diabetic?* —Please choose an option—YesNo

   1. What type of diabetes do you have?—Please choose an option—Type 1Type 2

   2. Do you inject insulin?—Please choose an option—YesNo

   3. Have you ever had hypoglycaemia (“a hypo”) —Please choose an option—YesNo

3. Are you a pregnant female?*—Please choose an option—YesNo

   1. How many weeks pregnant will you be on the last day of the voyage you are booking?* Please round up to the nearest week.

4. Do you suffer from sleep apnoea or use a CPAP machine?*—Please choose an option—YesNo

5. Do you suffer from severe vertigo, or motion sickness or have any problems with balance that may cause you to need assistance?*—Please choose an option—YesNo

6. Have you ever suffered from epilepsy or other forms of seizure?*—Please choose an option—YesNo

These are other conditions that must be disclosed to us at the time of booking. For certain vessels and voyages accepting your booking may be at the discretion of the owner or skipper of the vessel. In relation to any condition additional information may be required.

1. Do you suffer from asthma, or have any difficulty breathing?*—Please choose an option—YesNo

   1. Please tell us how this is controlled.

2. Do you have high cholesterol or use anti coagulants?*—Please choose an option—YesNo

   1. Please tell us how this is controlled.

3. Do you have high blood pressure or any other heart problems?*—Please choose an option—YesNo

   1. Please tell us how this is controlled.

4. Do you have any past medical conditions that you feel we should be aware of whilst you are on board?* —Please choose an option—YesNo

   1. Please tell us what it was, how long you had it, and how long it has been since it affected you.

5. Have you been admitted to hospital as an ‘in patient’ in the last 5 years?* —Please choose an option—YesNo

   1. What was this for; and what treatment was required?

6. Do you have an allergy to any food, or medicine, or anything else?*—Please choose an option—YesNo

   1. What is it/they and how does it/they affect you?

7. Do you have any sight problems except those that are rectified by glasses or contact lenses?*—Please choose an option—YesNo

   1. Please tell us what they are and how they affect you, in detail.

8. Do you have any other health issues we should be made aware of?*—Please choose an option—YesNo

   1. Please tell us what they are and how they affect you, in detail.

9. Do you have any mobility issues we should be aware of?* —Please choose an option—YesNo

   1. Please tell us what they are and how they affect you, in detail.

10. Please tell us about any medication you are taking now, or expect to be taking at the time of your voyage. Please note we may need to request additional information.

    Are you taking any regular medication?*—Please choose an option—YesNo

    1. Please list the medication and dosage

    2. You must bring all medication with you including extras in case of delay or loss, as well clear written instructions on dosages and how the medication should be taken. Your skipper must be make aware of all medication brought on board, whether ‘prescription’ or otherwise.

1. Please tell us about your dietary requirements*Eat anythingPescatarianVegetarianVegan

2. Do you have any dietary needs (optional).

Please read your vessels FAQs to learn more about the food served on board. We will try to accommodate your needs as much as possible.

Each vessel may have risk assessments and policies in place to minimise the risk of the transmission of infectious diseases aboard, including but not limited to COVID. However, the risk cannot be eliminated entirely.

By sailing with us you understand and agree to

1. the risk of contracting an infectious disease during your voyage

2. participating in additional health screening procedures, prior to joining the vessel that may result in you being unable to board.

3. abide by all infection control measures in place on board the vessel

Failure to comply with these measures may result in you be unable to join the voyage.

1. I understand and agree with the Infection Control DeclarationYes

I confirm that the information given is accurate and complete, and I understand that:

1. Some medical conditions may make a sailing holiday inadvisable and that my booking may be declined.

2. VentureSail must be made aware immediately, and prior to joining the vessel, of any changes to my medical conditions.

3. The skipper or owner of the vessel has the right to refuse to accept me on the voyage if not fully satisfied about any matters regarding health or safety.

4. If I fail to disclose any information I am fully liable for any cost and expense that falls due, in relation to but not limited to; being put ashore, transferred to another vessel, associated travel costs, delays to the voyage schedule, or repatriation.

1. Name

2. Date

3. I confirm that all details are correct

We need information about your health and medical conditions, some of which may be personal, for important safety reasons. Information will not be shared with any other organisations except the owners or managers of the vessel on which you will be sailing. All health and medical information given to VentureSail will be used in strict confidence, will be stored securely, and will be destroyed within 3 years of the end of your voyage.