Traveler Application Form

Personal Details (Please answer ALL questions)
Next of Kin
Your Doctor's Contact Information
Passport & Health Card (This is required for European travel)
*If you have your own insurance please provide the following details:
Medical Information
If you have a Care Plan please provide a copy Note: If there is any change in your medical condition or medication prior to travelling, then please inform the Group Leader or the Jumbulance Office .

Personal Hygiene
Night Time
IMPORTANT – PLEASE LIST ALL MEDICATION AND ATTACHED CHEMIST’S PRINT OUT AND BRING 10 DAYS SUPPLY OF MEDICATION AND DRESSINGS WITH YOU. If any of the above medication information should change before the date of travel please inform your group leader as soon as possible. Failure to complete this section properly will result in you being refused travel. .

General Information & Declaration
I confirm that the above information is correct and authorise the Jumbulance Trust or its representatives to seek confirmation from my Doctor if required. For insurance purposes I also confirm: That I am not travelling against the advice of a medical practitioner nor for the purpose of obtaining medical treatment abroad. That I am not expecting to give birth before or within eight weeks following the date of arriving home The group leader/s and/or Jumbulance Trust do not accept and you hereby release each of them from all and any liability or obligation to pay to you any compensation, costs or damages for any loss which you may incur a) as a result of any changes or delays in to the holiday arrangements and/or b) or for any damage or injury caused to you or any group member during the holiday howsoever arising.