Passenger Information Name: Date: Birthdate: Cell Phone Number: Email Address: Address: City: State: Zip Code: Tour You Are Booking: I am paying: A DepositIn Full Doctor's Name & Phone Number: Allergies (Example: Medications or Foods): Emergency Contact Name: Relationship to Passenger: Emergency Contact Phone Number: Medications (list all by brand name, include complete dosage information): Please list all health conditions we should know about: I have had the Covid-19 vaccination: YesNo Special birthday or anniversary you are celebrating during this tour: Enter your full name below to indicate the following: I understand that Jane’s Journeys, LLC, as a tour operator, does not assume and cannot be held liable for personal illness, such as Covid-19 or personal injury, property damage or other loss that may occur as a result of negligent acts or omissions on the part of any supplier. Δ You can download a copy of Jane’s Journeys LLC Passenger Information Form here.