Your name Your email Your phone number Describe your previous backcountry experience: Please describe your regular exercise program: Please describe your swimming ability: Select swimming abilityLike a fishGoodFairPoor Cannot swim Are you vegetarian, vegan, or neither?: Select optionVeganVegetarianNeither Please list any foods you will NOT eat: What are your favorite foods?: Your height: Your weight: (this helps us keep you safe) Your age: Do you have any allergies?: Do you carry an Epi-Pen...be sure it is current: Select optionYesNo Do you carry an inhaler? If so, please make sure you have plenty of medication left: Select optionYesNo Do you have a heart condition?: Select optionYesNo Do you have any orthopedic injuries or surgeries?: Select optionYesNo Do you take any regular medications?: Select optionYesNo Do you have any phobias that might affect you on this trip?: Do you wear corrective lenses? Make sure you bring an eyewear retainer strap: Select optionYesNo If you answered yes to any of the health related questions above or have any other medical or physical considerations that are necessary for us to know to keep you safe, please describe.: Emergency contact person: Emergency contact person's phone number: Is there anything else you think we should know about you related to this trip?: 20987Δ