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Insurance and Emergency Contact Information (USAT)
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Dear Coyote Tripper,
Safety is the #1 priority on all our trips. But in case something unexpected happens, we need to know a more little information. Please fill out the following form before you start your trip, or at least on the first day of your trip.
*
1.
What's your full
first name
?
*
2.
What's your
family name
?
*
3.
What is your
email address
?
We will use the email you submit here twice. First to send you a link at the end of our trip to ask you for a review & feedback and secondly to send you a discount coupon for any future Coyote Trips
*
4.
What is your personal
phone number
, including country code?
We will use this in case of emergency to try to contact you
*
5.
What is your
Trip Number
?
Please choose
Trip 1
Trip 2
Trip 3
Trip 4
Trip 5
Trip 6
Trip 7
Trip 8
Trip 9
Trip10
Trip11
Trip12
Trip13
Trip14
Trip15
None of Above
*
6.
What is the name of your
insurance provider
?
*
7.
What is your
insurance policy number
?
*
8.
What is your insurance provider's
phone number
including countrycode?
*
9.
What is the
name
of your
emergency contact
?
This person must be at least 18 years of age
*
10.
What is [q9]'s relation to you?
Parent
Sibling
Friend
Coworker
Others
*
11.
And what is [q9]'s
phone number
including countrycode?
Thank you for your time,
[q1].
By clicking 'submit' on this page, you agree to The Coyote Trip's Terms and Conditions
(
https://thecoyotetrip.com/terms-conditions/
) sent to you in your booking pack email
.
We wish you safe and pleasant journey with us!
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