Galapagos Islands Registration Form

Name*
First Last
Pronoun*
- She/Her
- He/Him
- They/Them
Personal Details
Birthdate*
MM slash DD slash YYYY
Email*
Enter Email Confirm Email
Phone number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Medical Information
Dietary Restrictions:*
Medications.*
Please list all medications (prescribed and non-prescribed) you are taking, if any. Include dosage/frequency and condition being treated. If you aren't taking medications, please state that in this field.
Do you have any pre-existing medical conditions or physical limitations that could affect your ability to fully participate in this active, adventure travel trip?*
Include ALL medical conditions, disabilities, past surgeries (especially related to hip/knee replacements, joint injuries, cardiac, etc.), mental health issues and any other health concerns you think could be relevant to your participation in this trip.
Do you have any known Allergies?*
- Yes
- No
If so, please list allergens, signs of reaction and describe the severity of your allergies.*
Are you required to carry an epi-pen?*
- Yes
- No

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Do you feel you have any psychological limitations?*
EG: Fear of water, fear of heights, anxiety etc.
Please tell us about your experience as a traveller and adventure lover.*

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Emergency Contact Name*
First Last
Emergency Contact Relationship*
Emergency Contact Phone Number*
Emergency Contact Email*
Dates & Payment
Date Selection*
Trip Payment Policy*
Once your registration form is submitted, an invoice for your trip deposit and remaining amount will be emailed to you. (This may take a few days to receive) You are able to make partial payments on the remaining balance. The full balance needs to be paid before 60 days from the trip start date. If you have not paid the remaining balance before 60 days of the trip start date then you are considered not coming and loose your spot on the trip. There are no refunds for any flight, activities, transportation or accommodations that have been booked and are holding your spot. If you have to cancel your trip for any reason there are no deposit refunds available. All permits booked are non refundable and non transferable as they are sold on an individual basis to your passport number. If you need to cancel your within 60 days of the trip date and have not paid the final trip payment you are responsible for paying the remaining amount owed for the trip. Total Trip Cost: USD$4350.00 Deposit: USD $435.00
Personal Travel Insurance*
- I understand and agree that I have personal travel insurance for this trip
Travel Insurance

Run Like A Girl Adventures Inc requires travel insurance for all of our trip participants and we work with World Nomads Travel Insurance. Travel insurance for independent travelers and intrepid families. You’d rather not think about all of the things that might go wrong on your trip, but these things can and do happen. Please check the box below to confirm that you will have travel insurance for this trip.

Purchase Travel Insurance
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Valid Passport Number*

Please enter your passport number. Please also ensure that your passport is valid at least 6 months after our scheduled adventure. Your passport number is used to book your entrance permits within the National Parks. We will be following up with an email asking for a photo copy of your passport.
Passport Expiry Date*
MM slash DD slash YYYY

Your passport must be valid 6 months following our trip dates.
Waiver
Please click here to read our waiver and check the box below to agree. This is mandatory! (Link opens in a new tab)
*
- I have read and agree to the waiver
Deposit*
This deposit is non-refundable deposit of USD$435.00. This deposit secures your spot for the chosen adventure date. You will be emailed an invoice shortly. Thank you so much!
- I want to get news and updates from Run Like a Girl!

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Personal Details

Medical Information

Dates & Payment

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