Alpenboxx European Adventure Tours Call us at (519) 744-3232 or +436643882976
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Participant medical questionnaire
*
Indicates required field
Name
*
First
Last
Tour Name and Date
*
EMERGENCY CONTACT NUMBER
*
EMERGENCY CONTACT NAME
*
Relation
*
The following questions are intended to remind Karrie and Participants of the seriousness of attempting adventure activities with an old, pre-existing injury, heart problem or other conditions which may be aggravated by the event.
Are you currently taking any prescription or non prescription medications? If yes, what medications and what are they for?
*
Any pre existing injuries (ankles, knees, back, shoulder, hip) that may be aggravated by the event? Explain
*
Do you have or have you had any of the following conditions
*
Heart Condition
High blood pressure
Low blood pressure
Allergies - food, bees, insects, medicines
Asthma
Chronic disability or illness - Epilepsy, Emphysema, Vertigo, Migraine headaches, fainting, motion sickness, ear problems
Other
None
Please elaborate further on any conditions above or any concerns you may have regarding this issue
*
Any special dietary requirements
*
When was the last full Medical you had at your Doctor
*
Do you foresee any problems participating in the upcoming adventure due to lack of physical exercise?
*
* I do advise a full physical examination prior to coming on this trip
I have honestly disclosed to Karrie Gregson any medical, psychological, or personal reasons that might affect my safety or the safety of others during these events. I will remember that a 'Challenge by Choice' Atmosphere exists at all time and I should not feel pressured to participate when I feel something detrimental to my health occurring. I certify that I have adequate insurance to bear any additional cost of injury or damage. I also certify that I have been advised to have a Physical Examination with my Doctor prior to coming on this trip.
Please check the box
*
I confirm the above statement to be true
Submit
Home
Information
Questionnaires
AGB
Trip Details and Documents
Get Started
>
Level of Difficulty
FAQ
Action Steps
Reserve Your Spot
MOUNTAIN PREP TRAINING
Packing List
Packing List Hike + Yoga
About Us
The VIDEOS
The PICS
RAVE REVIEWS
Philosophy
Contact & Info
ADVENTURE COACHING +
ADVENTURE COACHING
>
Week at a Glance
Mountain Summit Project - Phase 1 CHECK IN
Post Session Reflection
ALPINE ASCENT
Tours
Hiking Tours
>
La Palma Wild Soul Adventure
Catalonia Express
>
Cat Express Highlights
Tirolean Wild Soul Adventure
Hike + Yoga
>
EPIC AZORES HIKING YOGA
Hike + Yoga Dolomiti
Hike + Yoga Swiss Eiger
Madeira Hiking Yoga
Private Tours
Your Guides
Referral Program
Fitness/ YOGA
YOGA
Personal Training
>
Personal Training Questionnaire
Terms and Conditions Personal Training
Waiver
OUTDOOR BOOTCAMP
MAMA FIT
>
Mama Fit Packages and Pics
SUPERFOOD
>
Mind Body Reset
ISAGENIX The Art of Well-being
K's Rockin Recipes
Mountain Energy Bars
HOMEBASE FIT ONLINE WORKOUTS
Blog
Transalpine Run 2013
TRANSVULCANIA Ultramarathon 2014 - Luscious La Palma
Summer 2012
Transalpine Run 2012
UTMB Experience
Transalpine Run 2011
Cool Life List
Adventure Experience