Altitude Waiver Form
Please complete this form to acknowledge and accept the risks associated with high-altitude activities.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions we should be aware of?
*
No
Yes (please specify below)
If yes, please list your medical conditions:
Are you currently taking any medications?
*
No
Yes (please specify below)
If yes, please list your medications:
Do you have any allergies?
*
No
Yes (please specify below)
If yes, please list your allergies:
Type of Altitude Activity
*
Please Select
Hiking
Climbing
Mountaineering
Paragliding
Other
Date of Activity
*
-
Month
-
Day
Year
Date
Participant Signature
*
Submit Waiver
Submit Waiver
Should be Empty: