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PERSONAL
Full Name:____________________________ ____ Date of Birth:_________________
Marital
Status:_______________Occupation:________________________________________
Home Address:________________________________Home Phone:_______________
Work Address:________________________________Work Phone:________________
Fax:__________________________________Email:____________________________
NEXT OF KIN (Notify in case of emergency)
Name:_____________________________________ Home Phone:_________________
Address:_________________________________ Work Phone:___________________
SAFARI DATES & ITINERARY
Arrival:_______________________ Time:___________________
Port:_______________________
Depart:_______________________ Time:___________________
Port:_______________________
# of Days:______ # in Party:______ Hunters:_____ Observers:_____
Children:_____ Under12:_____
Hotel Req:___________________ Air Charter Req:____________________________
Special Arrangements:____________________________________________________
Photo Safari Arrangements:_____ Days:_____ Interests:_______________________
HUNTING REQUIREMENTS
Species
(specify):___________________________________________________________
Firearms: Make:__________________ Calibre (min .30):________
Serial No.:__________________
Make:__________________ Calibre (min .30):________
Serial No.:__________________
Cites Permits Required:__________________________________________________
FOOD AND BEVERAGE
Wine (W/R):____________ Beer:____________ Spirits:_________________
Minerals and Juices:__________
Food Preference:_______________________________________________________
Dislikes and Allergies:___________________________________________________
HEALTH
Allergies:____________________________ Bees:_________ Blood Type:________
Antibiotics:_________________________ Other:_________________________
INDEMNITY: I, THE UNDERSIGNED DO HEREBY INDEMNIFY THE MEMBERS AND STAFF OF BATELEUR
SAFARIS AND ITS ASSOCIATES OR PERSONS ACTING FOR OR ON ITS BEHALF AGAINST ANY LOSS OR
DAMAGE CAUSED DIRECTLY OR INDIRECTLY BY SICKNESS, INJURY, DEATH OR LOSS, OR DAMAGE TO
PROPERTY WHETHER OCCURRED BY NEGLIGENCE OR NOT, OR ANY EXPENSES ARISING THEREFROM,
WHICH I MAY SUFFER WHILE WITH BATELEUR SAFARIS.
Deposit Paid:_____________ Date:_________________ By:___________________
Signed by Client:_____________________________ Date:________________
Signed by Outfitter:___________________________ Date:________________
Comments:___________________________________________________________
Full Name:____________________________ ____ Date of Birth:_________________
Marital
Status:_______________Occupation:________________________________________
Home Address:________________________________Home Phone:_______________
Work Address:________________________________Work Phone:________________
Fax:__________________________________Email:____________________________
NEXT OF KIN (Notify in case of emergency)
Name:_____________________________________ Home Phone:_________________
Address:_________________________________ Work Phone:___________________
SAFARI DATES & ITINERARY
Arrival:_______________________ Time:___________________
Port:_______________________
Depart:_______________________ Time:___________________
Port:_______________________
# of Days:______ # in Party:______ Hunters:_____ Observers:_____
Children:_____ Under12:_____
Hotel Req:___________________ Air Charter Req:____________________________
Special Arrangements:____________________________________________________
Photo Safari Arrangements:_____ Days:_____ Interests:_______________________
HUNTING REQUIREMENTS
Species
(specify):___________________________________________________________
Firearms: Make:__________________ Calibre (min .30):________
Serial No.:__________________
Make:__________________ Calibre (min .30):________
Serial No.:__________________
Cites Permits Required:__________________________________________________
FOOD AND BEVERAGE
Wine (W/R):____________ Beer:____________ Spirits:_________________
Minerals and Juices:__________
Food Preference:_______________________________________________________
Dislikes and Allergies:___________________________________________________
HEALTH
Allergies:____________________________ Bees:_________ Blood Type:________
Antibiotics:_________________________ Other:_________________________
INDEMNITY: I, THE UNDERSIGNED DO HEREBY INDEMNIFY THE MEMBERS AND STAFF OF BATELEUR
SAFARIS AND ITS ASSOCIATES OR PERSONS ACTING FOR OR ON ITS BEHALF AGAINST ANY LOSS OR
DAMAGE CAUSED DIRECTLY OR INDIRECTLY BY SICKNESS, INJURY, DEATH OR LOSS, OR DAMAGE TO
PROPERTY WHETHER OCCURRED BY NEGLIGENCE OR NOT, OR ANY EXPENSES ARISING THEREFROM,
WHICH I MAY SUFFER WHILE WITH BATELEUR SAFARIS.
Deposit Paid:_____________ Date:_________________ By:___________________
Signed by Client:_____________________________ Date:________________
Signed by Outfitter:___________________________ Date:________________
Comments:___________________________________________________________
| BATALEUR SAFARIS |
| Fax/Tel: International (011)2714-743-2329 ~ Local (014)743-2329 P. O. Box 1619 ~ Potgietersrus ~ 0600 ~ South Africa |
| SAFARI RESERVATION FORM Please complete in full so we can cater to your needs. |