Climber Profile

If you have already completed a registration form, or if another person has registered and will be paying for you, then you have two steps left:

Your Climber Profile is used by our office and guide staff to provide the best possible service. Please fill out the form below in as much detail as possible.

Identifying Information

Full Name

Email Address

Phone Number - Mobile

Trip organizer (if another person is organizing and/or paying for your program).

Additional Contact Information (Please skip if provided in registration form.)

Address

Address (Cont'd)

City

State/Province

ZIP/Postal Code

Country

Personal / Background Information

Date of Birth

Occupation

Gender

Height and Weight

Please check all the boxes that apply to you.

I have done day-long hikes in the mountains.
I have camped overnight in the mountains.
I have cooked for myself on a backpacking stove.
I have backpacked, carrying all my camping gear myself, for at least two days and one night.
I have gone rock-climbing and/or mountaineering before.
I have previous experience on snowshoes, skis or a splitboard

If registering for AMTL 2, Alpinism 2 or higher level course, please check all the boxes that apply to you.

I have climbed a glaciated peak within the last 2 years.
I have climbed a multipitch alpine route within the last 2 years.
I have set up a crevasse rescue system within the last 2 years.
I can follow 5.8 (indoors or outdoors) rock climbing.
I can lead climb up to 45-degree ice.

Please list your most significant outdoor experiences. Be sure to include details to help us assess your preparedness for your program.

Please describe your physical activity and/or training during a normal week. What special training are you planning to prepare for your trip?

Other Interests

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Fitness and Medical Information

In the past two years, have you had any major accidents, illnesses, or surgeries?

No
Yes

If yes, please describe.

Have you ever experienced any form of altitude sickness?

No
Yes

If yes, please provide detailed information on rate of ascent, altitudes, medications taken, and how the illness was dealt with.

Do you have any physical limitations or medical / psychological conditions that might restrict your full participation in this program?

No
Yes

Specifically, have you ever dislocated a shoulder?

No
Yes

Do you have, or have you ever had, knee problems?

No
Yes

Have you ever had frostbite or any other cold injury?

No
Yes

If yes to any of the previous four questions, please describe.

Have you suffered any psychological stress injuries, accidents, or other adverse experiences that might affect your experience on this program?

No
Yes

If you answered 'yes' to the previous question, and you are comfortable discussing it here, please describe.

Please describe any medications, either prescription or over-the-counter, that you normally take, and the reasons you take them.

Are you or will you be in situations that put you at risk of exposure to COVID-19, prior to your program?

No
Yes

Please note here any recent or planned activities that could expose you to COVID-19, including crowded or indoor gatherings where you can not maintain 6 feet of separation.

Do you have a history of asthma, diabetes, heart disease, seizures, or severe allergies/anaphylaxis (caused by food, medications, bee stings, or others)?

No
Yes

If yes, please describe. Make sure to detail prescribed treatment procedures (such as inhaler, epi-pen, etc.)

Do you wear contact lenses?

No
Yes

Other notes/considerations

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