Anderson Travel and Tours

Medical Form – Motorcoach Tours

(phone you will have with you on the tour)
“DO NOT” LIST YOUR SPOUSE OR PARTNER who will be traveling with you! This MUST be a contact who will not be on this tour/motorcoach!
(spouse, child, other relative, guardian, friend, etc.)
EXAMPLES: pacemaker, ostomy, asthma, diabetes-insulin, epilepsy, cancer, recent surgery, bleeding disorder, taking blood thinner, etc.
EXAMPLES: food allergies, drug allergies, latex allergy, other allergies, insect stings, or anything else that could cause an allergic reaction leading to anaphylactic shock.
(In case of emergency)
(look on the back of your insurance card)