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Where in South Africa

Information Form

Reservation Form

Customer review

reservation form

Name:
Address:
City:
Zipcode:
Country:
Phone day (not mobile):
Phone evening (not Mobile):
E-mail:
Choice of hotel or apartment in Spain:
Supplements? Breakfast Half board Full board
The length of your stay in days :
The date of your stay: from Till

Do you need rental equipment in Spain:

Choice your travel package in South Africa:
12 days holiday sekf drive and car rental "BIG 5"
12 days organised group holiday "BIG 5"
7 days organised group holiday "BIG 5"
15 days organised group holiday "SAFARI"
Which month would you go to South Africa?
Name of persons travelling with you:
1. Name Age
2. Name Age
3. Name Age
4. Name Age


CONFIDENTIAL HEALTH & EMERGENCY INFORMATION
Please answer all questions thoroughly!

Date of birth:  
Sex : Male Female  
Your weight:  
Your height:  
Transfer in:
Self Propelled wheelchair or Motorized wheelchair
Will you require a shower/WC chair?     Yes     No
Your health insurance company and policy number:
The name of your physician & telephone number:
In case of emergency who should we call?
Name and phone number:  
note

DON'T FORGET YOUR TRAVEL INSURANCE

RELEASE OF LIABILITY:
Please read carefully and mark the checkbox below if you
agree to all of the terms.
I certify that the above information is true, accurate and complete. I certify that I and/or my companion(s) (including minor children) are fully capable of participation in the trip and booked activities. I hereby waive, release and discharge all actions, claims and demands for personal injury and/or property damage that may hereafter accrue against Wheels on Holiday, its employees, agents, hotels and/or resorts, arising out of ordinary negligence.
This agreement shall be governed by and constructed in accordance with the law of Spain.
I understand that in case of cancellation of my trip the deposit is non-refundable.
I have read, understand, and accept the terms and conditions stated in here and acknowledge that this agreement shall be effective and binding upon me and my companions during the entire period of my vacation.
Yes, I agree
PLEASE MARK THE CHECKBOX ABOVE AND E-MAIL IT TO
WHEELS ON HOLIDAY.
 
The sum of 1 and 6 is: