Guest Crew Application Part 1

Applicant Information
Name*
First Last
Nickname
Do you go by another name?
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone*
Email*
Are you comfortable allowing Pride, Inc. to distribute your contact information to fellow guest crew members for the purpose of making travel arrangements, sharing photos, etc.?*
- Yes
- No
Gender*
Date of birth*
Month
Day
Year
Height*
Weight*
Guest Crew Passages
First choice passage:*
Second choice passage:*

Medical Information
The captain must have knowledge of any medical conditions. Applicants over the age of 65 must provide documentation from their general physician or internist that, in their opinion, there is no apparent reason to prevent the applicant from participating as an overnight guest crew member aboard a sailing vessel.
Date of last physical exam*
Month
Day
Year

* An exam within one year of departure date is required.
Do you have any limiting physical conditions, physical challenges, or disabilities that may impact your movement on board?*
If yes, please explain:
Do you have any chronic illness/es (such as asthma, cardiovascular disease, diabetes, epilepsy, heart disease, hypertension, kidney or liver disease, osteoperosis, etc.)?*
If yes, please explain:
Do you have any special restrictions or allergies?*
If yes, please explain:
Do you have any mental or emotional challenges or conditions that may impact others in a group or impact your performance on board?:*
If yes, please explain:
Please list all medical conditions (if none, please type "N/A"):*
When was your latest (last) dental examination?*
Month
Day
Year
Do you have any pending dental concerns?*
If yes, please explain:
Prescription Drug Information
Please list all prescription drugs you intend to bring aboard PRIDE, the condition(s) they are treating, and any possible side effects if the medication is not available (if none, please type "N/A"):*

Applicant Information