Child Booking Form for Asian Adventure Holidays

If the Participant is under 18 years of age then this form needs to be completed by a parent or guardian of the child.

Please take the time to ensure that this information is accurate as we will use this information to book portions of the child's tour. Lost Earth Adventures cannot be held responsible for any problems that arise due to this form being completed incorrectly.

Please give us your chosen trip name:

Please tell us your Booking Reference Number:

Date of your chosen activity (dd/mm/yyyy):

Please give us the name of your group organiser or (lead name):

First name of Participant (as written on passport):

Middle names - If applicable (as written on passport):

Surname (as written on passport):

Date of Birth (dd/mm/yyyy):

Sex (M/F):

Please tell us the height of the participant (important):

Please tell us the weight of the participant (important):

Street Name and Number:

City:

County/State/Province:

Postcode:

Country:

Child's Passport Number:

Issue date:

Expiry date:

Place of issue:

Nationality:

Your Name:

Relationship with Participant:

Emergency Contact telephone number:

Alternative emergency telephone number:

Your email address:

Confirm email address:

Please answer the following 4 questions:

1. Does you child suffer from any medical condition? For example but not limited to; asthma, learning difficulties, epilepsy, allergies etc. (this does not necessarily prevent the child from taking part but we need to be aware):

2. Please describe and detail any medical condition your child has and any precautions they need to adhere to or dietary requirements (if none, write none):

3. Please list any recent injuries or illnesses (if none, write none):

4. If the child mentioned in this form is required to take any medication please list the name of the medication they take, the required dosages and times it is needed to be taken (if none, write none):

Optional: Additional Information:

By submitting this form you agree to the following 11 statements:

1. Your child participates in the activities provided by Lost Earth Adventures at their own risk. If they feel any pain, dizziness or other problems they should inform their instructor immediately.

2. I understand that Lost Earth Adventures accepts no responsibility for loss, damage, or injury caused by participating in the activities provided by Lost Earth Adventures except where such loss, damage or injury occurred due to the negligence of Lost Earth Adventures.

3. I consent to my child receiving medical treatment that in the opinion of a qualified medical practitioner may be necessary.

4. I consent to my child undergoing First Aid treatment from a member of Lost Earth Adventures staff holding a First Aid Certificate if required.

5. I accept that there is an element of risk involved in the activities that Lost Earth Adventures provides.

6. I will pay any applicable single supplement (unless you are content with your child sharing a room with yourself or your friend or relative).

On school or youth trips they will be sharing with other children of the same sex and no supplement will apply unless a single room is required.

7. I confirm that I will pay the amount quoted for each person by no later than 60 days prior to departure, and that this also applies to any single supplement which might be due.

8. I confirm that I will the pay the costs of any extras by no later than 60 days prior to departure

9. I understand that my child will not be allowed to travel without sufficient travel insurance.

10. I confirm that I will provide Lost Earth Adventures my child's insurance policy details including the company name of the insurer, the policy number and emergency contact details of the insurers before I depart on my chosen tour.

11. I confirm that I will fully declare to my child's insurers the nature of this trip accordingly.

How did you hear about us?

By submitting this information you are hereby agreeing to our Terms and Conditions available to see on our website here: Terms and Conditions and confirm that you have read them and the trip dossier for your child's trip. Please tick the box if you agree.

Mailing List
If you would like to be sent exclusive deals and details of our new up and coming adventures, please tick this box to be included in our mailing list. We promise to never send you more than 12 emails a year.

If you have any trouble reading the Terms and Conditions or if there is anything about them that you do not understand then you must call us on 01904 500094 and we will be able to send you a copy or explain them to you in more detail. Please do not submit this form until you have read, understood and agreed to our Terms and Conditions.

THIS FORM WILL NOT HAVE SUBMITTED UNLESS YOU HAVE ANSWERED EVERY QUESTION ABOVE. YOU WILL RECEIVE A THANK YOU MESSAGE ONCE IT HAS SUBMITTED SUCCESSFULLY.

Thank you for choosing Lost Earth Adventures. We hope that your child will find their holiday rewarding and fun.