Alpinism.com Guest Information Form

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This form is stored on a secure server (https). Only the guides have access to this information and it will remain confidential with the exception of food issues, which go to the cook. If you are on a backcountry lodge trip this information is also shared with the lodge owner.

IF YOU ARE UNCOMFORTABLE FILLING OUT THIS FORM ONLINE YOU MAY EMAIL ME THE INFORMATION

MOST QUESTIONS REQUIRE AN ANSWER. PLEASE WRITE "NONE" IF IT DOES NOT APPLY TO YOU. THANKS.

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Choose your trip *

First name *

Last name *

Date of birth *

YYYY

Provincial health care provider *

Provincial health care number *

Other health insurance provider *

Canadians need additional health insurance coverage if traveling outside Canada as your provincial insurance will not cover you overseas. Americans need health insurance that covers them in Canada and/or overseas.

Other health insurance number *

Mountain rescue insurance provider

Mountain rescue insurance number

Do you have any medical conditions we should know about? *

Do you use prescription medications? *

Prescription medications you use and what they are for

Emergency contact name *

Relationship *

Emergency contact relationship to you

Emergency contact mobile phone number *

I will not eat the following (catered trips only):

Please indicate food allergies and strong food preferences here. If you are anaphylactic to anything you need to bring your own Epipen(s).

Your cell phone number *

I need to borrow/rent:

Avalanche transceiver ($10/day)

Shovel (no charge)

Probe (no charge)

Harness (no charge)

Helmet (no charge)

N/A

其他：

Additional comments

Waiver *

I understand that I will need to sign a waiver that is a RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

必填

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