Prehike info form for adults Please fill out this form before going on your hike. Fields marked with an asterisk are required. Contact information First name:* Last name:* Email:* Phone:* Type of phone:* ---CellHomeBusiness Additional phone: Type of phone: Not applicableCellHomeBusiness Address Street address:* City:* State/Province:* Country:* Postal Code:* Personal attributes Date of birth:* Your age on trip departure day:* Gender:* Height:* Weight:* Shoe size: (Shoe size is requested in case traction devices are required for winter hiking.) Emergency Contact person Emergency contact name:* Emergency contact phone:* Relationship:* Health information Physical condition (1 is worst, 10 is best):* ---12345678910 Please describe your typical level of physical activity or exercise: Do you have existing injuries or illnesses?* ---YesNo If you answered yes, please describe: Do you have any physical limitations?* ---YesNo If you answered yes, please describe: Do you have any dietary restrictions?* ---YesNo If you answered yes, please describe: Do you have any allergies?* ---YesNo If you answered yes, please describe: Do you currently take or are you currently prescribed any medications?* ---YesNo If you answered yes, please list your medications/prescriptions and the reason(s) for them: Release of liability I understand the nature of activities that I will be participating in, and I acknowledge, agree, and represent that I am qualified, in good health, and in proper physical condition to participate in these activities. I understand that these activities involve inherent and serious risks, including serious bodily injury, permanent disability, paralysis, and death. I hereby release, discharge, and covenant not to sue other participants or Canyonology LLC or Canyonology LLC's employees, directors, managers, operators, officers from all liability, claims, demands, losses, or damages caused or alleged to be caused by Canyonology LLC or other above-listed parties. I understand that I will be asked to sign a liability waiver on the day of the hike, and that doing so is a prerequisite to my participation. Check this box if you understand and agree to the release of liability. Health, medical, and other terms Known and unknown pre-existing health conditions can increase the risk to trip participants. Guests with a medical history must notify Canyonology LLC of their medical history as soon as possible after signing up for a trip. If a new medical condition or incident develops or occurs after reporting your medical history to Canyonology LLC, it is extremely important to notify the company as soon as possible. Canyonology LLC reserves the right to deny or withhold services to anyone at any time on the basis of their health or well-being, or the health or well-being of others in a trip group. Outdoor activities carry inherent risks, and the magnitude and type of these risks may depend in part on the participant's physical condition. Participants are advised to seek a doctor's advice on what particular risks may be heightened on the basis of their medical history and physical condition. Under no circumstances does Canyonology LLC allow guests to possess, use, or be under the influence of any illicit substance. Any guest who possesses, uses, or is under the influence of an illicit substance will be disqualified or removed from the trip. Guests must understand and agree that Canyonology LLC may provide or arrange for services, including emergency medical or evacuation services, that the company or its employees deems necessary for the safety and well-being of guests. Guests must understand and agree that they are responsible for paying for these services. Check here if you understand and agree to the health, medical, and other terms. Photo release (optional) Canyonology LLC may use photos or videos from my hike for advertising, promotional, or marketing purposes. I release Canyonology LLC to use images of myself for these purposes. Check here to accept these terms (optional). To submit this form, enter the characters pictured below and click the "Submit" button. To use CAPTCHA, you need Really Simple CAPTCHA plugin installed.