THE SHACKLETON CROSSING
30 OCT – 20 NOV 2016
APPLICATION FORM
APPLICANT INFORMATION
Full Name:
(As it appears
on Passport)
First
Middle
Last
Address:
House Number / House Name / Apartment & Address
City & State
Home Phone:
Including
International
Dialing Code
Country
ZIP/Postal Code
Cell/Mobile Phone:
Including International
Dialing Code
E-mail address:
Passport Details:
Passport Number
Nationality
Expiry Date
Date of Birth
Age
Marital Status
Occupation:
Page 1 of 7
Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd
TELL US A BIT ABOUT YOURSELF
Shackleton’s men dreamt about food. What food do you like? If we can carry it on the expedition, we
will do our best to pack it.
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Hot Food/Sauce
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Ground Coffee
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English Tea
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Herbal Tea
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Vegetarian/Vegan
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Oatmeal, Nuts & Dried
Fruit
At home do you eat breakfast? Do you consider yourself a big eater? Do you snack during the day? Is
there anything we should know about your regular diet?
Briefly describe your outdoor experience including any cold-weather camping experience:
Describe your weekly fitness routine:
Describe any physical limitations that may be a challenge during The Shackleton Crossing:
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Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd
Do you practice medicine or do you hold any in-date medical qualifications? (first aid, wilderness
EMT, paramedic)
Have you ever sustained frostbite or any cold weather related injury or illness? Please describe:
Do you have any dietary restrictions?
How would a friend describe your personality? Briefly describe your expectations from the
expedition:
All expedition members will have the unique privilege of:
 Using the expedition logo for e-mail signatures, outdoor clothing
and technical equipment (please contact us for more information).
 Exclusive access to The Shackleton Crossing members only
webpage where you can see the expedition coming together.
 Post-expedition photo sharing using Dropbox.

 Recommended reading list.
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Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd
RESPONSIBILITIES
Responsibilities of Shackleton Legacy Ltd (that’s us):
Shackleton Legacy Ltd exists to bring history back to life through expeditionary work in South
Georgia. We will work closely with each team member to achieve individual and team goals.
Shackleton Legacy and its employees, agents, outfitters, and owners act only as the agent s for certain
tour operators, shipping companies, hotel operators and travel services. Shackleton Legacy Ltd only
assumes responsibility for organizing The Shackleton Crossing which includes: the supply of
technical polar travel equipment and provisions, the organization of permits, the expedition route
plan, the environmental impact assessment, risk assessment, and securing the services of suitably
qualified and experienced Mountain Leaders.
☐
I acknowledge the above responsibilities and agree to observe these.
Responsibilities of Expedition Team Members (that’s you!)
The expedition leader has the right to disqualify anyone at any time during The Shackleton
Centenary Voyage if he or she feels the team member is physically incapable and/or if the team
member’s continued participation will jeopardize The Shackleton Crossing group. Neither refunds
nor credits are given under such circumstances.
It is the participant’s responsibility to complete a medical and insurance declaration as required for
the expedition permit. Shackleton Legacy Ltd will send you these forms upon receipt of a complete d
application form. It is also the participants responsibility to read the pre-departure information pack
including ‘what to expect’ – ‘what to pack – ‘how to prepare/train’. It is the participant’s
responsibility to ensure the pre-departure check-list is completed and returned to Shackleton Legacy
Ltd prior to departure.
☐
I acknowledge the above responsibilities and agree to observe these.
ITINERARY
Polar travel by nature is very dynamic. Though Shackleton Legacy Ltd will make efforts to minimize
any problems, it is important to understand that changes are sometimes necessary and we reserve the
right to do this if the expedition is compromised in any way.
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I acknowledge the above information about the itinerary.
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Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd
PAYMENT & CANCELLATION
We will not ask you for a deposit until we have submitted the details you provide on this application
form to the permitting authorities and have received acceptance of your involvement.
Once your application has been accepted a non-refundable deposit of 20% is required to confirm your
position. Reservations are taken on a first come/first serve basis as space is limited to 12 participants
plus 3 professional mountain leaders. The final balance may be paid by cheque or bank/wire transfer.
The balance is due 120 days prior to departure and we reserve the right to charge the balance or resell
the space, if the balance is not received when due. Prices for The Shackleton Crossing are in USD.
Cancellation Policy:
Shackleton Legacy Ltd reserves the right to alter the expedition plan if safety is compromised. If the
Crossing is seriously compromised, we reserve the right to cancel the expedition. If cancellation
occurs before departure a full refund will be made. If cancellation is necessary following
departure, no refunds will be made. Under no circumstances will Shackleton Legacy Ltd be
responsible for any expenses incurred by expedition participants.
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I acknowledge the above information about payments and cancellations.
WEATHER RISK
Shackleton Legacy Ltd (in partnership with Ice Tracks Expeditions & Polar Latitudes) will make
every effort to facilitate a successful crossing of South Georgia. Given the nature of weather
conditions on the island we cannot be absolutely certain that a crossing will be feasible. In the
interest of every participant’s safety, it could be necessary to scale down the expedition plan or
modify the overland route within the limitations of the expedition permits.
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I acknowledge the above risk.
APPLICATION CONFIRMATION
Upon receipt of your 20% deposit we will send you comprehensive pre-departure information
including what to expect, what to pack, how to prepare, a suggested reading list, and much more.
From that point until the departure of the expedition we will be in regular contact with you via phone
and e-mail to ensure that all your questions are answered and to help you prepare for this incredible
experience. Please contact us at any time with questions.
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I acknowledge the above responsibilities and agree to observe these.
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Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd
LIABILITY COVER & INSURANCE
Shackleton Legacy Ltd and its employees, agents, outfitters, and owners, assumes no liability for loss
of, or damage to, personal property, injury, or loss of life. It is a mandatory requirement for
expedition participants to have medical evacuation insurance to undertake The Shackleton Crossing,
and proof of this cover will be required for the expedition permit. Shackleton Legacy Ltd will supply
the specification for this insurance at a later date. Please contact us if you have any questions.
☐
I acknowledge the above responsibilities and agree to observe these.
WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
In consideration of being allowed to participate in any way in The Shackleton Crossing Expedition
(30 Oct – 20 Nov 2016) on the island of South Georgia,
I,
the undersigned agree to the terms and conditions for participation. I understand that in joining this
Shackleton Legacy Ltd expedition, I will be faced with certain inherent risks to danger in a remote
geographic area where shore based hospital treatment is not available.
In making an application to participate in The Shackleton Crossing, I affirm that I know of no
medical reason that would prevent me from completing the expedition. I am capable of performing
the required exercise to participate, and that I accept the hazards associated with The Shackleton
Crossing and will not hold Shackleton Legacy Ltd, Ice Tracks Expeditions or Polar Latitudes, its
representatives, or their other participants responsible.
FULL NAME
EMAIL
ADDRESS
CITY
REGION/STATE
POSTAL CODE
COUNTRY
E-SIGNATURE
DATE
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Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd
EXPEDITION CHECK LIST
In applying for this expedition I understand that I have certain responsibilities. These include: (Please
initial each item)
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Thoroughly reading and
studying pre-expedition
information, including the
confirmation of personal
equipment list.
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Purchasing medical
evacuation insurance (as
specified).
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Carefully reading,
completing and returning all
forms including the
confidential medical report,
liability waiver, and
insurance form.
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Keeping Shackleton Legacy
and Ice Tracks Expeditions
informed regarding my
travel itinerary.
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Bringing appropriate
clothing and equipment as
advised by Shackleton
Legacy.
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Contacting Shackleton
Legacy with any questions
or concerns relating to the
Centenary Voyage or
Mountain Crossing
This completes your application.
Thank you! This application can be scanned and returned by e-mail to: [email protected]
Original signed documentation to be mailed to Shackleton Legacy Ltd, please contact us at the above
email for the postal address.
Page 7 of 7
Applicants Name:…………………………………………………………. The Shackleton Crossing 2016
Shackleton Legacy Ltd