Prehike info form for multi-day trips Important note: The form below asks for the distance between your iliac crest (top of hips) and vertebra C7 (base of neck). This is used for sizing your pack, and it can vary quite a bit even between people of the same height. Pack fit can make the difference between a good hike and a great hike. If you don't plan on bringing a well-fitting backpack from home, please complete this measurement before filling out the form. 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 At least one of the phone numbers above should be a cellular phone on which you can be reached while traveling 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 as a precaution for search-and-rescue purposes, and in case traction devices are required for winter hiking.) Pre- and post-hike travel plans How and when will you be arriving in the Grand Canyon area? Please include pertinent information such as flight numbers and connecting/arrival airports.* Where will you be staying the night before your hike?* Where will you be staying the night after your hike? (This information is helpful for returning lost items and other miscellaneous follow-up.)* Pack sizing information The two fields below are required to complete the form. If you plan on bringing your own backpack, please write the letter X in place of an actual measurement. Waist size (inches):* Iliac crest to C7 (inches):* Important note: The distance from "iliac crest to C7" is used for sizing your pack harness — it is the distance between the top of your hips and the base of your neck. This can vary quite a bit even between people of the same height, so please take care to measure this correctly! Emergency Contact person Emergency contact name:* Emergency contact phone:* Relationship:* Health information Do you meet the essential eligibility criteria for outings? ---YesNo Physical condition (1 is poor health/endurance, 10 is Olympic-caliber athlete):* ---12345678910 Please describe your typical level of physical activity or exercise: Do you have any existing injuries, illnesses, or diagnosed conditions?* ---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 printed 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. To submit this form, enter the characters pictured below and click the "Submit" button. To use CAPTCHA, you need Really Simple CAPTCHA plugin installed.