Full Name:

Nationality:

E-mail:

Date of Birth:

Blood Type:

Hotel & Rm No:

Contact in case of emergency:

Please inform us of any of the following:

Allergies/Illnesses (current or recent); Medication taken regularly; Any other conditions you
think we show know about and necessary details. (EG: wasp/bee or medication allergies,
epilepsy, diabetes, asthma, penicillin intolerance, pregnancy etc)
wasp/bee allergiesmedication allergiesepilepsydiabetesasthmapenicillin intolerancepregnancy

How well can you swim? Strong ( ) Medium ( ) Not at all ( )
StrongMediumNot at all

Are you vegetarian or have any other dietary requirements?

Visitors must always be aware the risks involved in any adventure activities. Such risks
include dangers such as slippery rocks, falling, poisonous animals, flash floods, thermal
shocks, drowning, among others.
Many areas have very difficult access in case of rescue and there is NO car access in many
situations. Depending on location and severity rescues will be carried out on foot or by pack
animals or in extreme situations by helicopter.
There is a basic medical centre in Lençóis, for minor injures
For more serious injures there is a hospital in Seabra (80kms from Lençóis)
In extreme cases it is necessary to go to Salvador (384km from Lençóis)
I declare that:
- All details given above are correct
- I have been made aware of the risks involved above and the conditions of rescue in case of
emergency by Discover Chapada Turismo.
- I will respect the advice and decisions of my guide at all times.