Mountaineering Expedition Activity Waiver Form
Complete this form to participate in the mountaineering expedition and acknowledge the activity waiver, safety risks, and emergency contact requirements.
Participant Information
Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Expedition Details and Safety Information
Expedition Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Planned Route / Expedition Name
*
Please Select
Route A
Route B
Base Camp Ascent
Summit Attempt
Other
Emergency Contact Name
*
First Name
Middle Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mountaineering Experience Level
*
No prior experience
Beginner
Intermediate
Advanced
Other
Medical or Physical Conditions Relevant to Expedition Safety
Waiver Acknowledgment and Signature
Participant Signature
*
Submit
Submit
Should be Empty: