Participant Declaration and Contact Information

Please complete the information exactly as it appears in your passport – please fill out one per person.

PARTICIPANT DECLARATION AND CONTACT INFORMATION

No sophisticated medical facilities are available in the Polar Regions. Our vessels carry a qualified physician and have a limited infirmary with basic medications and equipment. Passengers are further advised that medical evacuation, if available, is expensive, and we strongly recommend you acquire medical insurance that would reimburse you for this cost. Please note, the locations being traveled in are very remote, and in the areas where Medevacs (Medical Evacuations) are possible, it might take up to 2 days to be reached. This expedition is therefore intended for persons in reasonably good health. Passengers who are not fit for long trips for any reason, including disability, heart or other health conditions, are advised not to join the tour, as it would entail an unreasonable risk to your health and the safety of you and others on the expedition.

Together with your Travel Agency, Polar Latitudes (PLX) require you complete this confidential personal Participant Declaration so that the shipboard physician is fully aware of your medical conditions and needs and can better care for you onboard. This is part of PLX’s obligation for self-‐sufficiency under the terms of the Antarctic Treaty System. In addition, you are expected to carry your own regular medications, which may not be available aboard.

PRIVACY POLICY

Your personal information belongs to you and it is important for PLX to protect what you share with us. The purpose of PLX's personal data policy is to explain in a concise and transparent way how we collect, transfer, use and protect your personal information. PLX has a clear ambition of minimizing the distribution of your personal information and creating a high degree of transparency in relation to this information.

The medical information collected in this form will be deleted at the completion of the voyage.

Personal Information

Last name as it appears in passport *

First name as it appears in passport *

Gender *

Nationality *

Passport number *

Passport issue date (DD/MM/YYYY) *

Day

Month

Year

Expiration date (DD/MM/YYYY) *

Day

Month

Year

Medical Information

Travel Insurance Company Name *

Insurance policy number *

Emergency Contact Information *

Please provide the full name and phone number including country code of your emergency contact.

Dietary restrictions and allergies *

Mobility restrictions *

Medical Information *

Please declare your prescribed vital medications (Medication name, doses, etc.)

Remarks and Illnesses, Disabilities or Infirmities *

Please declare your existing medical information! (Pre-existing injuries, conditions, etc.)

Traveler's Health Statement *

Yes

I attest that I am in good general health, and capable of performing normal activities on this expedition. I further attest that I am capable of caring for myself during the expedition, and that I will not impede the progress of the expedition or the enjoyment of others aboard. I understand that this expedition will take me far from the nearest medical facility and that all travelers must be self‐sufficient. With that understanding, I certify that I have not been recently treated for, nor am I aware of, any condition, physical nor psychological, or disability that would create a hazard to myself or other members of the expedition. I also attest that I have adequate travel insurance to cover including medical evacuation, travel interruptions, denied boarding and repatriation.

Traveler's Agreement to Comply with Safety & Health Protocols *

Yes

I attest that I will comply with the Safety & Health Protocols onboard the vessel and understand that not complying may lead to denied boarding, and that a positive test may lead to quarantine onboard.

Rental Information

Boot Size *

For both our Arctic and Antarctic voyages, we loan sturdy, high-quality boots free of charge throughout the duration of your trip. While we strive to provide guests with boots that match their exact size, individual variations may occur, and we cannot always guarantee a perfect fit or the size selected. Boots are available in sizes EU35 to EU48.

Terms & Conditions *

Yes

I hereby confirm that I have read and accepted Polar Latitudes' General Terms & Conditions: https://polar-latitudes.com/terms-and-conditions/