Traveler Safety

Emergency Contact Form

Your safety is our top priority on every trip. Please complete this form before your departure date — it helps us respond quickly and effectively if you ever need assistance on the road.

Required for all travelers. Required for all travelers. This information is kept strictly confidential and used only in the event of a medical emergency.

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Traveler Information

First name

Last name

Date of birth

Phone number

Email address

Trip you are registered for

Street address

City

State

ZIP code

Emergency Contact

Full name

Relationship

Primary phone

Alternate phone

Email address

Medical Information

Primary physician name

Physician phone

Health insurance provider

Policy / member number

Blood type

Known allergies

Current medications

Medical conditions or diagnoses

Special needs or accommodations

Consent & Signature

By submitting this form, I authorize Steve's American Adventures and its staff to act on my behalf in the event of a medical emergency during any trip I participate in. I understand that this information will be kept strictly confidential and used only for emergency purposes.

I certify that the information provided above is accurate and complete to the best of my knowledge. I agree to notify Steve's American Adventures of any changes to this information prior to my trip departure.

Full name (electronic signature)

Date

Questions? Call us at (352) 476-2797 or email [email protected]