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Jungle Chill
Ocean Trek – Terekhol
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Coconut Island and Neuti Experience
Expedition Neuti
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Learn to Sail
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Swim Bambolim – Dona Paula
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Eye Climbing Wall
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Activity Page
Activity Page
Thank you for choosing Adventure Breaks!
It is
MANDATORY
to fill out the following form to confirm the booking.
Activity Name
(Required)
Select Your Activity
Trekking
Kayaking
Solo Traveler
Expedition
Climbing
Sailing
Coasteering
Sea Swim
Email
(Required)
Date of Activity
(Required)
Day
Month
Year
Choice of Kayaking
(Required)
Morning Beach Kayaking
Sunset Kayaking
Secret Beach Kayaking
Moonlight Kayaking
Chorao Chillout Kayaking
Choice of Trekking
(Required)
Ocean Trek Neuti Beach
Ocean Trek Sea Cave
Four Beaches Jungle Hike
Ocean Hike Crabs Claw Bay
Ocean Hike Eagles Cliff
Ocean Trek Cabo de Rama
Jungle Chill
Ocean Trek Hippie Trail
Wilderness Hike
Ocean Trek Devil's Finger
Choice of Solo Travel
(Required)
Ocean Trek Sea Cave
Four Beaches Jungle Hike
Ocean Hike Crabs Claw Bay
Ocean Hike Eagles Cliff
Ocean Trek Cabo de Rama
Ocean Trek Hippie Trail
Choice of Expedition
(Required)
Coconut Island and Neuti Experience
Expedition Neuti
Choice of Climbing
(Required)
Agonda Climb
Eye Climbing Wall
Choice of Sailing
(Required)
Learn to Sail
Morning Sail
Lunch on the Sea
Evening Sunset Sail
Sail Around Panaji
Choice of Sea Swim
(Required)
Mandovi Swim
Swim Bambolim - Dona Paula
Lunch on the Sea
Evening Sunset Sail
Sail Around Panaji
Full Name
(Required)
Date of Birth
(Required)
Day
Month
Year
Age
(Required)
Gender
(Required)
Male
Female
Blood Group
(Required)
A
A-
B
B-
AB+
AB-
O+
O-
Weight
(Required)
(in kgs)
Height
(Required)
(in cm)
Phone Number
(Required)
Emergency Contact
(Required)
(PLEASE SHARE THE CONTACT INFORMATION OF A PERSON NOT JOINING YOU FOR THE ACTIVITY)
Allergies
(Required)
Any physical ailment? (IF YES, PLEASE SPECIFY)
(Required)
Fear of Heights
(Required)
Do you own a pair of climbing shoes?
(Required)
Yes
No
Other
T-shirt size?
(Required)
XS
S
M
L
XL
Other
What is your trousersize?
(Required)
What is your shoes size?
(Required)
(UK size)
Kayaked before?
(Required)
Yes
No
Trekked before?
(Required)
Yes
No
Climbed before?
(Required)
Yes
No
Sailed before?
(Required)
Yes
No
Do you have motion sickness?
(Required)
Yes
No
Do you know to swim?
(Required)
Yes
No
Food Option
(Required)
Veg
Non veg
Are you vaccinated against Covid - 19?
(Required)
1st dose
2nd dose
No
Do you need a backpack?
(Required)
Yes
No
(20 liter backpacks are available on rent at 50/- per day. Please add this to the activity fee)
Country
(Required)
State Domicile
(Required)
Profession/Occupation
(Required)
How did you hear about Adventure Breaks
Social Media Advertising
Facebook
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Reference from a friend
You know a member of Adventure Breaks
Google Search
Instagram handle? (We promise to follow back ;))
On submission of the above details, you agree to our Indemnity clause that states: "I am participating in the Trekking Activity with Adventure Breaks out of my own free will and at my own risk entirely. I hereby totally and unconditionally indemnify Adventure Breaks, the organisers, the instructors, the team and all others associated with this activity from any claims whatsoever arising from any loss to self, dependents, and/or property in the event of an accident resulting in injuries or death before, during and after the activity."
(Required)
Agree
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