Fillable Special Needs ENG FINAL 21538 02 Special Needs Form.indd

Fill Online, Printable, Fillable, Blank Special Needs ENG FINAL 21538 02 Special Needs Form.indd Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Special Needs ENG FINAL 21538 02 Special Needs Form.indd

On average this form takes 17 minutes to complete

The Special Needs ENG FINAL 21538 02 Special Needs Form.indd form is 4 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 66 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
MSC Cruises S.A. - Avenue Eugène Pittard, 40 - 1206 Geneva (Switzerland)1 of 4
SPECIAL NEEDS FORM
MSC Cruises S.A. is sensitive to its passengers’ needs and constantly strives to offer the best possible service in
accordance with all the relevant international standards. To enable us to provide a service that is tailored to your
particular requirements, we kindly ask you to read this form carefully and duly complete it at the time of booking.
This will allow us to
prearrange your arrival on board so that your accommodation is as comfortable as possible,
and to inform you about life on board your chosen vessel and any potential difficulties you may encounter.
Every effort has been made to ensure that the content of this form is accurate;
however, MSC Cruises S.A. advises you to check with your travel agent for the most up to date information.
PASSENGER DETAILS
BOOKING No.:
________________________________________________________________________________________________________________________________
APPLICANT’S NAME AND LAST NAME:
__________________________________________________________________________________________________
DATE AND PLACE OF BIRTH:
______________________________________________________________________________________________________________
ADDRESS:
_____________________________________________________________________________________________________________________________________
CONTACT DETAILS (phone, e-mail, etc.):
_______________________________________________________________________________________________
NAME AND LAST NAME OF THE HELPER (if required):
______________________________________________________________________________
N.B.: A helper may be necessary depending on the passenger’s degree of autonomy and chosen accommodation.
PARENT/GUARDIAN DETAILS
N.B.: If the applicant is a minor and/or incapable, this form should be completed and signed by a parent having
parental responsibility, or by the guardian, details of whom must be provided.
NAME AND LAST NAME:
___________________________________________________________________________________________________________________
DATE AND PLACE OF BIRTH:
______________________________________________________________________________________________________________
ADDRESS:
_____________________________________________________________________________________________________________________________________
CAPACITY:
________________________________________________________________________________________________________________________________
CRUISE DETAILS
SHIP:
_________________________________________________________________
DATE OF DEPARTURE:
___________________________________________
DESCRIPTION OF PACKAGE:
  CRUISE ONLY CRUISE AND FLIGHT
CABIN Nr.:
__________________________________________________________
DISABLED CABIN REQUESTED:
  YES
  NO
MSC Cruises S.A. strongly recommends that passengers with reduced mobility - regardless of the type and
severity of their condition - request in a specially-equipped stateroom, because using an ordinary stateroom could
cause difficulties and inconvenience.
CABIN NR.
DISABLED CABIN REQUESTED:
MSC Cruises S.A. strongly recommends that passengers with reduced mobility - regardless of the type and
severity of their condition - request accommodation in a specially-equipped cabin, because using an ordinary
cabin could cause difficulties and inconvenience.
MSC Cruises S.A. - Avenue Eugène Pittard, 40 - 1206 Geneva (Switzerland)
MEDICAL DETAILS
MEDICAL CERTIFICATE OF FITNESS TO TRAVEL ON THE CRUISE TRIP:   YES   NO
(and if applicable on the flight)
ILLNESS(ES):
__________________________________________________________________________________________________________________________________
MEDICAL TREATMENT REQUIRED ON BOARD:
_______________________________________________________________________________________
AIDS/EQUIPMENT TO BE TAKEN ON BOARD:
_________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
MSC Cruises S.A. reminds you that it is your exclusive duty and responsibility to bring on board any medicines
and/or equipment which you may need during the cruise, as such items may not be available from the on-board
medical facilities. It is also your exclusive duty and responsibility to administer medicines and undergo any other
treatment necessary in the on-board medical centre, as indicated by your own physician. MSC Cruises S.A. strongly
advises you to carry your medicines and/or medical equipment in your hand luggage.
DIETARY REQUIREMENTS:
_________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
MSC Cruises S.A. reminds you that, once on board, you should also advise the Reception and/or the Maître d’Hôtel
of your dietary requirements. MSC Cruises undertakes to provide meals for coeliac passengers exclusively on
board the vessels MSC Splendida, MSC Fantasia, MSC Magnifica, MSC Musica, MSC Orchestra and MSC Poesia, only
during travel in the Mediterranean and Northern Europe; all the motor vessels carry a selection of pre-packaged
gluten-free products on board during every itinerary.
2 of 4
PREGNANCY:   YES   NO WEEK:
___________________________
MSC Cruises S.A. informs pregnant women that they must present a medical certificate which - taking account
of their age, progress of the current and any previous pregnancies, any concurrent conditions and any other
relevant factors - confirms their fitness to undertake the proposed journey, as well as the week of pregnancy.
MSC Cruises S.A. also informs you that the medical facilities and equipment on board may be technically inadequate
for the purposes of childbirth, or to deal with complications in pregnancy, and that during a cruise circumstances
may arise which present a potential risk to the pregnancy (such as, for example, the swaying movement of the
vessel, adverse weather conditions, fatigue during excursions, sudden changes in weather, excessive noise and
possible bus transfers, etc.).
GUIDE DOG:
  YES   NO
MSC Cruises S.A. welcomes guide dogs on board its cruise vessels, on condition that they are in good health and in
possession of all documents necessary for entry to the foreign countries visited during the cruise (in particular, for the
EU the animal will require the compulsory identification document issued by the competent local health authority,
stamped within the 24 hours preceding the journey by the veterinary surgeon certifying the animal’s physical
condition). MSC Cruises S.A. will give prior notice to the passenger concerning the accommodation granted to the
animal, any facilities available for it and the relevant arrangements for embarkation and disembarkation of the vessel.
The passenger, on his/her part, undertakes to be personally responsible for the custody, nutrition and general care
of the animal throughout the period spent on board (with the help of his/her helper or fellow traveller if applicable).
ALLERGIES:
___________________________________________________________________________________________________________________________________
OTHER REQUIREMENTS:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
MSC Cruises S.A. - Avenue Eugène Pittard, 40 - 1206 Geneva (Switzerland)
ASSISTANCE ON BOARD AND/OR AT THE PORT
PASSENGER’S DEGREE OF AUTONOMY:
________________________________________________________________________________________________
DOES THE PASSENGER REQUIRE ASSISTANCE WITH EMBARKATION/DISEMBARKATION?   YES   NO
DETAILS OF ASSISTANCE REQUIRED:
___________________________________________________________________________________________________
MSC Cruises S.A. informs passengers that special means of transport from and to the terminal could result in
additional costs payable by the passenger. In the event that such services are requested and available, MSC Cruises S.A.
undertakes to give you prior notice of the details.
WHEELCHAIR DETAILS
DESCRIPTION:
ELECTRIC   FOLDING   SCOOTER   OTHER SIMILAR EQUIPMENT
IF ELECTRIC, BATTERY USED:
GEL   DRY
MSC Cruises S.A. informs passengers that wet batteries may not be brought on board its vessels.
DIMENSIONS WHEN OPEN:
DIMENSIONS WHEN FOLDED:
WEIGHT:
in
________________________
x in
____________________
x in
_____________________
in ________________________
x in
____________________
x in
_____________________
_________________________
kg
3 of 4
ASSISTANCE AT THE AIRPORT AND/OR DURING THE FLIGHT
MSC Cruises S.A. informs you that each airport and air carrier has its own restrictions, and we therefore ask you to
notify us in good time of any special needs, so that we can forward the information to the air carrier in sufficient
time for your requirements to be met. In any case, since the air carrier is a third party and not MSC Cruises S.A.,
it may take a few days to confirm the availability of the service requested. The option of using your own wheelchair
to access the stairs/door of the aircraft may be available, depending on the airport of departure.
BOARDING DETAILS:
WCHR (The passenger is able to use the stairs and move from the entrance of the aircraft to their assigned seat)
WCHS (The passenger is NOT able to use the stairs, but can move from the entrance of the aircraft to their
assigned seat)
WCHC (The passenger is immobile, i.e. he/she is NOT able to use the stairs and is NOT able to move from the
entrance of the aircraft to their assigned seat)
DIFFICULTY IN WALKING LONG DISTANCES (special assistance will be requested from the air carrier and/or the
airport for the purpose of travelling between the check-in and boarding gate, or from the gate of disembarkation
to the arrivals area):
  YES   NO
REQUIREMENTS RELATING TO THE SEAT DURING THE FLIGHT:
__________________________________________________________________
___________________________________________________________________________________________________________________________________________________
MEDICAL EQUIPMENT NEEDED DURING THE FLIGHT:
______________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
DIETARY REQUIREMENTS DURING THE FLIGHT:
_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________
MSC Cruises S.A. - Avenue Eugène Pittard, 40 - 1206 Geneva (Switzerland)
MSC Cruises S.A. also informs you that:
The vessel has limited medical facilities and equipment which may consequently be technically inadequate for the
treatment of your condition and potential complications related to it, and the medical staff on board may not have
the specific expertise required.
The means of transport used for excursions (provided by third parties and not MSC Cruises S.A. and not included
in the holiday package) may not be technically suitable for your specific needs;
The Captain has the power in any event - acting on the advice of the on-board Medical Officer - to refuse, at his
entire discretion, to allow you to embark, or to require you to disembark at any time and at any port, at your own
cost, in the event that your safety is likely to be compromised by the vessel.
In accordance with the relevant legislation, the Data Controller of the personal data, voluntarily supplied by you
completing this form, is MSC Cruises S.p.A., with registered office at via Agostino Depretis No. 31, Naples (Italy),
against whom the rights prescribed by the above legislation may be exercised. Your personal data will be processed
in full compliance with the relevant legislation in force and will not be disclosed to third parties, except in the event
that disclosure is necessary to fulfil a contractual obligation, or pursuant to legal requirements or where expressly
permitted by law; in any event, your data will not be shared.
MSC Cruises S.A. confirms, finally, that completing and signing this form does not of itself render effective the sale
contract for the holiday package, which - as set out in the General Terms and Conditions of Sale - remains subject
to confirmation by the Company.
The undersigned, on his/her part, declares that:
• the information provided above is complete and truthful and that he/she consents to it being processed in
accordance with the above arrangements;
• he/she has read and accepts the General Conditions of sale and transportation as included in the relevant
MSC Cruises S.A. brochure;
• he/she has informed his/her own physician of all circumstances relating to the holiday package selected, and the
physician, having taken account of those circumstances, has issued a certificate confirming fitness to undertake
the cruise trip (and, where applicable, the flights), which the undersigned has attached to this form;
• he/she has been fully informed of all circumstances which are potentially prejudicial to his/her health and safety
and that he/she has decided in full knowledge of the facts to purchase the holiday package, accepting the risks
relating thereto and hereby releasing MSC Cruises S.A., its agents, its insured, insurers, ship owners, the captain
and crew members of the vessel and/or any other party involved in any way (referred to collectively as the
“Company”), from all civil and/or criminal liability arising from the occurrence of medical emergencies relating
to his/her own medical condition, for which the on-board medical assistance proves to be inadequate, deficient
and/or unavailable;
• that he/she also releases the Company from all civil and/or criminal liability relating to medical treatment and
care to which he/she submits voluntarily, to the condition and operation of equipment which he/she brings on
board and, generally, relating to all matters declared above.
4 of 4
Date
______________________________________________________________
Signed
____________________________________________________________
MSC Cruises S.A., as data controller with headquarters in Geneva (Switzerland), and other companies of the MSC Cruises group acting as data processors, such as MSC Crociere S.p.A.,
with registered office in Naples (Italy), process your personal data for the purposes declared on this form in accordance with the EU Regulation on data protection 2016/679 (“GDPR”).
You can exercise your rights set out in Articles 15-22 GDPR, as applicable, by
sending an email to privacyhelpdesk@msccruises.com. If you believe that the processing of your personal
data infringes the GDPR, you can lodge a complaint with your supervisory authority. To learn more about data processing and privacy at MSC Cruises please read our Privacy
Information Notice available in your Booking Confirmation, your e-Ticket and in the MSC for Me App or contact our Data Protection Officer at dpo@msccruises.com.
After you complete the above information, please save this form and email this document to
mscexistingreservations@msccruisesusa.com.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Special Needs ENG FINAL 21538 02 Special Needs Form.indd

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document