Custom Trip Request

Flexible Dates

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Choose the dates of your stay

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Guest 1		First Name* Last Name* Email* Gender
Guest 1		First Name* Last Name* Email* Gender

First Name *
Last Name *
Email *
Phone	Add + and country code for Whatsapp users.
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Gender
Passport number	Required for insurance.
Birth Date
Height
Weight
Shoe Size
Arrival Date
Arrival Time
Arrival - Airline & Flight Number
Departure Date
Departure Time
Departure - Airline & Flight Number
Retreat Travel and Flight Policy	Most flights are to and from Temuco (ZCO) or Santiago (SCL) Airports. See scheduled arrival / departure. SCHEDULED airport transfers are included with all-inclusive trip rates ONLY if during published arrival and departure times. Guests may schedule airport transfers on dates / times outside of published times for additional transport fee.
I have read, understand & agree to the Travel & Flight Policies*	YesClick here to view the following releases.

Emergency Contact Info *	Name, Relation, Phone, Email
Participant Release *	I have read, understand and agree to the Pucon Kayak Retreat Policies & Participant Releases. Please click to view the following releases.
Waiver Release *	I have read the waiver and agree to the terms. Please email a copy of the signed waiver to David@PuconKayakRetreat.com. Please click to view the following releases.
Model Release. *	By checking box I agree to permit PKR to use media of my likeness for promotional purposes such as social media and website.