Wufoo

DMBH booking form

Date you would like to book? * DD / MM / YYYY
required
Personal Details
Name * Title First Last Suffix
required
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

required
Date of Birth * DD / MM / YYYY
required
Email *

required
Telephone
Biking Experience
How do you rate your fitness? (1=not very fit, 5=very fit)
How do you rate your riding ability? (1=beginner, 5=pro)
Health and Medical
Have you had a serious illness in the last 2 months?
Yes No
Do you have any medical conditions we should know about?
Are you on any medication?
Do you have any special dietary needs?
Next of Kin
Their Name First Last
Their relationship to you.
Their Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Their Telephone No.
Payment Options
How would you like to pay?
I'd like to complete payment now please. I will arrange payment separately via cash, cheque or bank transfer.
Miscellaneous
If there are any other details or comments you would like to pass on to us, please provide them below, thanks!
Agreement
By agreeing to the following, I declare that I have detailed all my medical conditions that may be of concern to Devon Mountain Biking Holidays. I consent to actions that include any emergency first aid treatment provided with the best of intention by any qualified staff involved. I understand that Devon Mountain Biking Holidays will make every reasonable effort to contact me and/or my next of kin as soon as reasonably possible regarding such treatment. *
Yes, I agree! No thanks!

required
Do Not Fill This Out

Wufoo

DMBH booking form

Personal Details

Biking Experience

Health and Medical

Next of Kin

Payment Options

Miscellaneous

Agreement