Basic Mountaineering Course Application Form
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First Name *
Last Name *
Address 1 *
Address 2
City *
Province *
Zip/Postal Code *
Country
Email Address *
Phone (mobile)
Phone (other)
Emergency Contact: First name *
Emergency Contact: Last name *
Relationship
Address 1 *
Address 2
City *
Province *
Zip / Postal Code *
Country
Email Address *
Phone (mobile)
Phone (other)
What are your motivations for taking this course? *
Do you have skills or training which would benefit the course? (e.g., medical, technical, first aid, avalanche)
Please provide brief details of any other experience relevant to your participation on the intended course:
Did you sign up for the "Introduction to Rock Climbing" Course? *
(Required if not signed up for the Intro to Rock Climbing Course) Briefly describe your rock climbing experience: How long have you been rock climbing? Indoors and/or outdoors? What is the hardest grade that you can climb?
(Required if not signed up for the Intro to Rock Climbing Course) Do you know how to tie a rope to a climbing harness?
(Required if not signed up for the Intro to Rock Climbing Course) How often have you belayed a climbing partner on top rope? What kind of belay device do you use?
(Required if not signed up for the Intro to Rock Climbing Course) Rappelling Experience: How often (roughly) have you rappelled? Where? When? Do you know how to use a backup prusik?
Do you have any allergy or medical conditions that we should know about? If yes, please explain.
How would you rate your current fitness level? *
Low
Excellent
Please outline any regular physical activities on your schedule: *
Please provide any further comments, special requests, or interests that you have:
I've read and understand the disclaimer. *
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