Cruise Guests Information Form

We at Cruise Holidays of Port Coquitlam want your cruise experience to exceed your expectations. Let us take care of all the details

*Full Name:  (As it appears on your passport/documents)

*Sailing Date: eg. 08aug2010

Dining Options:

Dining with Other Quests: (Specify)

Select Early Dining Late Dining Any Time Dining

Table Size : 

Select Table for 2 Table for 4 Table for 6-8 Table for 8-10

Select Singles Queen/king

Special Diet::

Food Allergies:

Wheelchair Required for embarkation and dis-embarkation?

Yes

No

Special Needs: Select all that apply.

Own Wheelchair:     

Hearing Loss

Hearing Accessibility Kit 

ASL Interpreter

Raised Toilet Seat

Own Scooter:   

Own Oxygen 

Visually Impaired:    

Own Service Animal  

Cruise Line Member Number. If Applicable:

Special Occasion

Celebration Date eg. 08aug2010

Select Anniversary Birthday Other