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Name: |
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Email: |
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Program: |
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Program Date: |
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1. What are your objectives for this trip? |
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2. What is your fitness level? Excellent, good, fair or poor? |
Excellent Good Fair Poor |
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3. Describe your fitness program: |
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4. Please list any medical conditions that would affect your endurance, strength or agility |
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If you are participating in a backpacking, walking or multi-sport adventure please skip to question 13 , otherwise please complete questions 5-12 . |
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5. Please list (with dates) instructional courses you have taken: |
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6. Please list the climbs/trips (with dates) you have done with guides: |
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7. Please list the climbs/trips (with dates) you have done with friends: |
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8. Do you rock climb? If so state the level which you second comfortably. If you lead, at what level do you consistently lead? |
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9. Please list your experience using ice axe, crampons, on glaciers and on step snow and ice: |
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10. Briefly outline your ski ability and backcountry experience. What equipment do you ski on? |
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11. Which of the following skills can you perform? |
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12. Which of the following knots can you tie? |
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13. Please list other backpacking or hiking trips you have done |
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14. What weight are you comfortable carrying in a backpack |
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