PolarExplorers Required Documents

  • PolarExplorers Medical & Waiver Form

  • Welcome to the PolarExplorers Medical & Waiver Form This form gathers information about your medical history and includes a waiver for your expedition. Please read it carefully and answer all questions honestly and fully. The form includes required fields which will prevent it from being submitted without completion. If you have any questions about the medical form or waiver please contact us!

     

  • Before you start, we recommend taking a look at our privacy policy. Would you like to do that now?*

  • PolarExplorers Privacy Policy

    At PolarExplorers we respect the privacy of our clients and their personal information. We collect the minimum amount of data needed to respond to a request for information or to register someone on our expeditions.

    The data we collect, including medical data and other personal data, is only provided to people who need to have it for the safety and success of the expedition.

    We collect data typically via online forms, electronic forms and hard copy paper forms. The security of the forms is as strong as the email servers and the online servers used to create and transmit the forms (that includes your email server). We think it's smart to assume that anything online can be breached, and therefore, we can make any form available through PDF or hard copy which you can fill out by hand and send by post or by fax to us. Just let us know.

    We may also collect information regarding the use of our website, including, for example, traffic volume, frequency of visits, etc. 

    Client information is never shared or sold for commercial purposes.

    People who supply PolarExplorers with their email addresses may receive periodic emails about upcoming expeditions, etc. Upon request we will immediately cease sending these updates and offers.

    Please let us know if you have any questions or concerns about your privacy.

    Thank you!

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  • Covid vaccination is required to join our expeditions. Please select the following regarding your covid vaccination status:*
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  • Have you ever tested positive for COVID?*
  • Do you have any present medical issues?*
  • Does your health prevent you from participating in any physical activities?*
  • Are you taking any medication*
  • Have you had surgery or been hospitalized for any reason?*
  • Do you smoke? If so please indicate how much in the pop up window:*
  • Have you ever suffered from seizures?*
  • Do you suffer from headache, dizziness or fainting?*
  • Have you had problems with neck, back, arms, ankles or knees?*
  • Do you have any bleeding problems?*
  • Do you have diabetes or endocrine problems?*
  • Have you had frostbite or reactions to cold?*
  • Have you suffered from muscle cramps, heat exhaustion or reactions to warm temperatures?*
  • Do you have any eating disorders (anorexia or bulimea)?*
  • Have you ever been under the treatment of a psychologist or psychiatrist? If so, list reason and date of treatment in the pop up window:*
  • Women: Do you have problems related to your menstrual cycle?
  • Women: Are you taking birth control pills?
  • Women: Are you pregnant or nursing?

  • All About Feeding You

    Food is important! Give us some insight about feeding you:
  • Please tell us about your food palate. What do you drink in the morning and/or evening?

  • Do you like hot sauce?*
  • At home do you eat breakfast?*
  • Do you consider yourself a big eater?*

  • RELEASE OF LIABILITY:

    I certify that the information provided on this form is a complete and accurate statement of the physical and psychological factors which may affect my participation on a PolarExplorer’s trip.  I realize that failure to disclose such information could result in serious harm to myself and other participants and I agree to indemnify and hold  PolarExplorers harmless if all relevant information is not disclosed.

    My permission is given for emergency anesthesia, operation, hospitalization, evacuation or other treatment which might become necessary.

    I hereby release and discharge the PolarExplorers/ The Northwest Passage Outing Club, Inc. and all its staff from any claims, suits or damages for personal injury, property damage or aggravation of an existing health condition resulting from my participation in a PolarExplorer’s trip.

  • Additional information and doctor approval:

    We may ask for clarification regarding a condition, medication or other treatment. We may also ask for written approval from your doctor to join this expedition. 

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  • Waiver, Release of Liability, and Assumption of Risk Agreement

    Please read carefully!

  • To print a copy of this waiver click "Print Form" (located at the very bottom of this form after the Polar Pack Boutique.)

  • In consideration of being allowed to participate in any way on the expedition(s) listed above and any related events and activities, I the undersigned, acknowledge, appreciate, and willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. I understand that in joining this PolarExplorers / The Northwest Passage Outing Club, Inc., (hereafter “PE/NWP” Outing, I will be faced with certain inherent risks and exposures to danger in geographic areas which may be remote from facilities where medical treatment can be obtained. I, the undersigned, acknowledge, appreciate and agree that the risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death. Such hazards may include, but are not limited to: falling, falling objects, temperature exposure (hypothermia, frostbite, frostnip, sunburn, snow blindness), altitude sickness, collision, chartered aircraft failing, crashing or otherwise causing bodily harm, falling through the ice, upset, striking obstructions or other persons, unsafe speed of travel for conditions or experience, equipment failure, inadequate or improper instruction or assistance, failure to wear protective clothing, elevation changes, weather conditions including electrical storms, exposure to wild animals, collapse of natural or man made structures, potable water contamination, and inadequate or improper skills and experience of participants and guides. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the release’s or others, and assume full responsibility for my participation.

     

    I understand that by joining this expedition and with the related travel I might be exposed to COVID-19. I understand that PE/NWP cannot protect me 100% from exposure and that despite their best efforts I may be increasing my risk of exposure and infection by joining this expedition.

     

    I, for myself and on the behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the PolarExplorers / The Northwest Passage Outing Club, Inc., its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (release’s), from any and all claims, demands, losses, and liability arising out of or related to any injury, disability or death I may suffer, or loss or damage to person or property, whether arising from the negligence of the release’s or otherwise, to the fullest extent permitted by law. Should I be injured on this Outing I understand that various expenses may be incurred in rendering rescue operations and medical care, and I agree that I will be responsible for any such costs of evacuation procedures, rescue operations and emergency or non-emergency medical services which may be occasioned by my participation in the Outing.

     

    In making application to participate in the Outing, I affirm that I am in good health, capable of performing the required exercise to participate, and that I accept, at my personal risk, the hazards of such participation in the Outing and will not hold PE/NWP, its members, other participants or its representatives responsible. In consideration of PE/NWP accepting my application, I hereby release and forever discharge PE/NWP, its officers, directors, servants, employees and agents and the other participants from any liability whatsoever arising as a result of my participation in the Outing. This release is binding upon me, my heirs, executors, administrators, and assigns.

     

    I have read this Release of Liability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.                    

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  • Are you signing this waiver for a minor?*

  • FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

    This is to clarify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Release’s from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, even if arising from negligence of the Release’s, to the fullest extent permitted by law.

     

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