Participant Profile Form

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?:

Δ