Explore WA Info Sheet

EXPLORE WA CLIENT INFO SHEET & T/C DECLARATION

Client Information

Name

Address

Best Contact

Emergency Contact & Name

If you have health information we require to know, please list below. If you wish not to disclose, we suggest you write down relevant information and place into a sealed envelope, which can be stored in your vehicle glovebox. In the event of an emergency, this critical information can be accessed.

Vehicle Information

Make and Model

Vehicle Rego

Please let us know a short modification list. ( Eg Tyres / Suspension / Winch )

Fuel Type

Petrol Diesel

Fuel Capacity (L)

Snorkel Fitted

Yes No

Is insurance currently hold for this vehicle

Yes No

Driver suitably licensed

Yes No

Rated Recovery Point

Yes No

Do you have a Valid National Parks Pass

Yes No

If you have a valid WA Parks Pass for your vehicle, please provide expiry

Trailer Rego

Will you bring a camper trailer along with the trip

Yes No

(Please note some trips are not suitable for camper trailers)

Occupant Information

Number of occupants travelling in your vehicle on this adventure

How many of occupants are 6 > 12 years old

How many of occupants are under 6 years old

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Email Address *

First Name

Last Name

General Information

Request more information or make general comments:

Terms & Conditions

I have Read & Agree with Explore WA's Terms & Conditions & Booking Policies

Submitting this form is a requirement to be part of our adventures. You can contact us on 0406108480 or by email ADMIN@EXPLORE-WA.NET should you need to discuss further. We look forward to having you join us on the adventure!