AFRIKA
BARREL & BOW
SAFARIS
P L E A S E    C O M P L E T E     T H I S    F O R M
ALL  INFORMATION  WILL  BE  KEPT COMPLETELY  CONFIDENTIAL

This original form must be completed and mailed or faxed to the above address

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P E R S O N A L    I N F O R M A T I O N
TITLE:_________
 FIRST NAME(S):________________
 SURNAME:_______________
ADDRESS:______________________________________________________________
______________________________________________________________
TOWN / CITY:_________________________
STATE / REGION:___________________
POSTAL/ZIP CODE:___________________
COUNTRY:________________________
TELEPHONE NUMBER:_________________________
(PLEASE INCLUDE AREA CODE)
FAX NUMBER:________________________________
EMAIL  ADDRESS:____________________________
PERSON TO CONTACT IN CASE OF EMERGENCY:
FULL NAME:_____________________________________________________________
FAX NUMBER:____________________
TELEPHONE NUMBER:___________________
EMAIL  ADDRESS:_______________________
ADDRESS:______________________________________________________________
______________________________________________________________
STATE / REGION:___________________
TOWN / CITY:________________________
COUNTRY:________________________
POSTAL/ZIP CODE:___________________
T R I P    I N F O R M A T I O N
DATES FROM:___________________________
 TO:__________________________
DON'T KNOW:  ______
# OF HUNTERS:_________
 # OF NON-HUNTERS:________
 # OF CHILDREN:______
SPECIES WANTED:_______________________________________________________
_____________________________________________________________________
_____________________________________________________________________
ARE YOU A BOW OR RIFLE HUNTER ?:
 BOW: ______
RIFLE: ______
 BOTH: ______
IF BOW HUNTER PLEASE SPECIFY:
 TRADITIONAL : _____
 COMPOUND : _____
WILL YOU BRING YOUR OWN BOW / FIREARM?:
 YES: ______
 NO: ______
WILL YOU BE DOING A PHOTOGRAPHIC SAFARI BEFORE OR AFTER THE HUNT?
YES: ______
 NO: ______
IF SO PLEASE SPECIFY:_________________________________________________
_____________________________________________________________________
PLEASE TELL US YOUR FOOD & BEVERAGE PREFERENCES:
FOOD LIKES:            ____________________________________________________
FOOD DISLIKES:       ____________________________________________________
FOOD ALLERGIES:   ____________________________________________________
WINE:                        ____________________________________________________
BEER:                       ____________________________________________________
SPIRITS:                   ____________________________________________________
JUICES AND SOFT DRINKS:_______________________________________________
DO YOU REQUIRE A LOW-SALT, DIABETIC OR ANY OTHER SPECIAL DIET?:
YES:_____
 NO:_____
IF SO PLEASE SPECIFY:_________________________________________________
PLEASE TELL US ABOUT YOUR HEALTH
DO YOU HAVE A SPECIAL MEDICAL CONDITION?_____________________________
ARE YOU TAKING ANY SPECIAL MEDICATION?_______________________________
ARE YOU ALLERGIC TO INSECTS / ANTIBIOTICS ETC?________________________
WHAT IS YOUR BLOOD TYPE?______________
P. O. BOX 4577
MOKOPANE
0600
SOUTH AFRICA
CEL : 082 356 5081
TEL : (+27) 15 453 0780
FAX : (+27) 15 453 0780
EMAIL : marco@barrelandbow.com
INDEMNITY FORM


TO BE SIGNED BEFORE THE HUNT

I, the undersigned, do hereby indemnify the members and the staff of BARREL AND BOW SAFARIS and any and all
of its associate companies, organizations, or persons acting for, or on its behalf, against any loss or damage,
whether it is caused directly or indirectly by delays, sickness, injury, death, or loss or damage to property, whether
occurred by negligence or not, or any expenses arising there from, which I may suffer while with BARREL AND BOW
SAFARIS or while under its control or custody.

I agree to abide to the decision of my Professional Hunter to take down any trophy with his rifle, if in his discretion;
this animal holds a threat to human life or needs to be put out of misery. I agree to pay all costs in full, that are
incurred, before termination of the hunt, which may arise from my Professional Hunter taking down these wounded
or life-threatening animals.  I also agree that photographs taken during the safari may be used for promotion and/or
publicity purposes by BARREL AND BOW SAFARIS.





Client Signature...........................................................              Date............................................





Observer Signature.....................................................                Date............................................





Witness.......................................................................             Date............................................



(I agree that any dispute, of whatever nature, that may arise from my involvement/association with BARREL AND
BOW SAFARIS will be adjudicated in terms of the laws of the Republic of South Africa. I specifically submit to the
jurisdiction of the Magistrates Court of Mokopane, Limpopo Province, Republic of South Africa for any nature of
claim. I also agree that BARREL AND BOW SAFARIS may however institute any proceedings in a competent High
Court in South Africa.)


** NOTE :  We do require a copy of the picture page of your passport and is necessary for South African
documentation