Guest Questionnaire

Guest Questionnaire
Contact Information
Name*

Full First NameFull Last Name
What do you prefer to be called?
Nickname
Phone Number*
Please enter a valid phone number with country code.Format: +1(000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Relationship*
Personal Details
Date of birth*

YearMonthDay
Date
Height*
Weight*
What gender do you identify as?
What pronouns do you use?
Medical Information
Chronic illnessesAsthmaHigh blood pressureHeart conditionsSiezuresDiabetesRecent and/or relevant surgeriesRecent and/or relevant fractures or injuries to ligaments or tendonsBack and/or neck injuriesJoint injuriesSleep disordersAnxiety and/or depressionMental health diagnosisUncorrectable vision impairmentUncorrectable hearing impairmentOther - please describe belowNone
Do you have any adaptive needs or equipment that your guide needs to know about?*
Are there any other physical or mental health conditions that you would like your guide to know about?*
Are you currently taking any medications, including prescription and non-prescription?*
YesNo
What is your common reaction to it?*
YesNo
Diet
VegetarianVeganLactose intoleranceGluten intoleranceNut freeNo shellfishNo fishNo red meatNo poultryNo porkKosherHalalOther - please describe belowNone
Please tell us more about any food allergies, what their cause is (illness, choice, allergy) and what your reaction is if exposed.
IngestTouchInhaleNo reaction
Fitness & Experience
2000ft or 610m vertical gain in a day.3000ft or 914m vertical gain in a day.4000ft or 1219m vertical gain in a day.5000ft or 1524m vertical gain in a day.greater than 5000ft or 1524m vertical gain in a day,
up to 2 hours a day.up to 4 hours a day.up to 8 hours a day.up to 12 hours a day.more than 12 hours a day.
I haven't rock climbed before.up to 5.6.up to 5.8.up to 5.10.greater than 5.10.
Please describe your climbing and camping experience.*
YesNo
If yes, please tell me as much as you can about your experience - the objective, guide service, guide's name, and month/year are helpful.
Describe your current level of fitness and exercise routine.*
Final Notes
Yes, I am a member.No, I am not a member.
Yes, I am a member.No, I am not a member.
Yes, I have purchased Trip Insurance for this booking.No, I have not purchased Trip Insurance for this booking.
Shwag!

I've got some fun stuff to say thank you with, so if you don't mind letting me know...
My favorite t-shirt size is:
Mens/Unisex or Women's, XS - XXL
My waist size is:
Don't worry - for my Alps clients I have a sweet belt and belt buckle!
That's It!

Thank you for taking the time to fill out this questionnaire.
Is there anything else you want me to know?
Should be Empty:

Guest Questionnaire

Contact Information

Emergency Contact

Personal Details

Medical Information

Diet

Fitness & Experience

Final Notes

Shwag!

That's It!