Guest Name *

Date of Birth: *

Guest E-Mail *

Guest Phone (please include country code) *

Passport Issuing Country: *

Passport Number: *

Emergency Contact Name: *

Emergency Contact Phone (please include country code): *

How Did You Find Out About Us? (e.g. friend, internet search, social media, press, other?)

Trek Start Date: *

Arrival Date to Guatemala: *

Arrival Flight Time: *

Departure Date from Guatemala: *

Departure Flight Time: *

Lodging In Antigua (for briefing & pick up): *

Lodging at Lake Atitlán (for drop off): *

Travel/Medical Insurance Provider: *

Travel/Medical Insurance Policy Number: *

Travel/Medical Insurance Provider Contact Number: *

If you have any previous or existing injuries or medical conditions that could affect your physical ability, please list them below:

If you are taking any medications related to the above injuries or medical conditions, please list them below:

If you have any significant known allergies, please list them below:

If you have any dietary restrictions (i.e. gluten-free, vegetarian, other), please list them below:

Beer

Wine

Liquor

Please let us know anything else that will help us make your trek as safe and comfortable as possible: