General Info & Health Declaration

Please fill out the following form (one form per person) in order to participate in our activity.

First Name

Last Name

Email

Height

Date of Birth

Weight

Dietary restrictions

Allergies

Exposure to Altitude?

Yes

No

If yes, provide details.

Mental Illness?

Yes

No

If yes, please elaborate.

Please describe your current fitness level/activities.

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering/ Have You suffered from a medical condition, illness, or injury?

No

Yes

If Yes to the above, please elaborate

Your Signature

I declare that the info I’ve provided is accurate & complete

I accept the Risk & Responsibility terms. (Download & sign before trip start date) View terms

Thanks for submitting!

Contact

PO Box 7635 Mammoth Lakes, CA 93546

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