Booking form
Please fill in all the lines as this will make booking easier. After receiving this form, we will send you an invoice and contract by email (or post if email is not available). Please return the signed contract to us, make the first payment of your voyage and your booking will be compete. If you have any questions, please send us an email on info@tecla.nl.

The booking form is only valid for 1 person. If you would like to make a second booking, please fill in the form twice and let us know with whom you are traveling in the box combination voyage. Also state here what other voyage you would like to make, if you are looking to make a combination between voyages.

Email address *
Naamloze titel
Naamloze titel
Your personal details
Please fill in your details for our contract
Name *
Your answer
Last name *
Your answer
Address *
Your answer
Area code (postcode) *
Your answer
City *
Your answer
Country *
Your answer
Passport or ID nr *
Your answer
Nationality *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Male / Female
Telephone nr
Your answer
Name and Contact details for next of kin *
Your answer
Voyage details
Voyage # *
Required
Combinations voyage (please fill in the voyage number or person you are traveling with)
Your answer
Health declaration
Please answer truthfully *
Yes
No
Do you need help in climbing stairs or taking thresholds of 60 cm (2 ft)?
Are you by experience very prone to motion sickness (sea sickness) ?
Do you have diabetes?
If yes, do you need injections?
Do you have any respiratory problems (e.g. Asthma)?
Do you have any heart or vascular problems?
Do you have epilepsy?
Do you have an increased risk for infections or did you have radio- chemotherapy in the past 24 months
Do you use anticoagulants (blood thinners)?
Have you been denied a driver’s licence on medical grounds?
Are you pregnant?
Is there another medical condition of which we should be notified? If yes please specify below
Medication
Your answer
Known Allergies
Your answer
Just some last information, please select if applicable
By sending this booking and Health Statement I declare to have answered these questions truthfully and that I am aware that I will participate in a voyage on TECLA at my own risk.
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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