Emergency Contact, Dietary Preferences, &
Special Requests


Date of Cruise:
Destination:
Yacht:
Your Email Address:

Travel Agency you booked through (if applicable)

PART 1: Emergency Contact Information

GUEST 1
Full Name:

Name of person to contact in case of an emergency:

Your relationship to them:

Their Phone Number:

GUEST 2
Full Name:

Check here if the above information applies to Guest 2.
If so, please scroll down to next section.

Name of person to contact in case of an emergency:

Your relationship to them:

Their Phone Number:


PART 2: Dietary Preferences & Medical Conditions

GUEST 1

1. Do you have any special dietary requirements (diabetic, low fat, salt free, etc)?
None

2. Do you have any special medical conditions? No

3. Do you have limited mobility? No

4.Do you have hearing, visual or comprehensive difficulties? No

5. Other?

6. Will you have entered the 3rd trimester of pregnancy by the time you sail with us?
Yes No

GUEST 2

1. Do you have any special dietary requirements (diabetic, low fat, salt free, etc)? None

2. Do you have any special medical conditions? No

3. Do you have limited mobility? No

4.Do you have hearing, visual or comprehensive difficulties? No

5. Other?

6. Will you have entered the 3rd trimester of pregnancy by the time you sail with us?
Yes No


PART 3: Special Occasion

Is there a special occasion being celebrated on the cruise? No
Date


Miscellaneous Information:

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