Participant Informational Packet

PARTICIPANT INFORMATIONAL

PACKET

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This information is confidential and will be shared only as needed with

trip leaders and medical care providers.

This informational and medical form provides us with information required for expedition

management and emergency situations. By requesting this medical history, we do not

imply that we have the expertise to assess your physical condition, or your ability to

participate safely in this program. If you have any doubts about your ability to participate

in this trip, please consult with your physician. Please complete fully so our guides and

program managers can adjust activities as needed to meet your needs and manage your

participation as well as the participation of others in the group.

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Global Treks Expedition (provide name and dates of trip): _______________________

Participant Information (Required)

Name: Phone #:

Address: Date of Birth:

Preferred Name (if differs from legal name above): _____________________________

Preferred Email Address: ________________________________________________

Emergency Contact Information (Required)

Name: Phone #:

Address: Relationship to Participant:

Height ______ Weight ______

Preferred T - Shirt Size (Women’s XS - XL sizing available): _______________

Client Information and Medical History Form

Global Treks and Adventures, LLC