Medicines & Emergency Contacts

Dear participant,

As we prepare for our exciting trip to Singapore and Malaysia, we need some important information from you! Please fill out this questionnaire carefully to ensure we can address all necessary requirements and emergencies during the trip. Please complete this form by ..th of December. Thank you for your cooperation! Let’s make this trip memorable and safe.

With lively greetings,

the Macie '23-'25

Velden met een * zijn verplicht.

Personal InformationWhat is your first name? *
What is your last name? *
Who is your emergency contact? (First + last name) *
Emergency contact relation to you: *
Emergency contact phone number: *

Health and Medication

For information about your medications and the Opium Law, check this website

Do you take any prescription medications that may require a medicine passport under the Opium Law? NOTE: This would be medications for ADHD, pain relief, or other controlled substances. *
If yes, please specify *
Do you currently have a medicine passport? *
If not, will you be able to obtain a medicine passport before the trip if required? NOTE: This can be obtained via your pharmacy (and sometimes your general practioner).
Do you have any medical conditions we should be aware of? *
If yes, please specify *

Additional NotesIf there is anything else we should know to ensure your safety and comfort during the trip, please let us know:

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Medicines & Emergency Contacts

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