Book a Spot with Intrepid

 






REGISTRATION FORM

A completed registration form is required to join these trips. You will not be confirmed for the trip until your form has been received and reviewed. We may ask for a medical release signed by your physician for medical conditions or circumstances which could possibly compromise your safety or the safety of others on this trip.

trip information

contact Information

For contact while you are traveling. Alternatively you could put down a number where we can reach you while traveling.

Where are you staying the night before your trip begins?
Medical and Personal Information

MM/DD/YYYY (please do not enter a 2-digit year)

Why do we ask for height and weight? For equipment fit including backpacks and sleeping bags. We respect your privacy and your information will only be shared with our booking team and your guide who will be preparing your gear.

Do you have any special dietary restrictions or requirements? NOTE: Tell us now; it’s too late once you arrive.

If yes, please summarize your dietary requirements here.
Physical Activity Key:
    • Extremely Active: Vigorous exercise (significant heart rate increase/very difficult
      to talk in complete sentences) at least 5-6 days/week. Long runs, bike
      rides, swims, HIIT, crossfit, or other athletic activity.
    • Very Active: Work out regularly (significant heart rate increase/can talk in
      short bursts of words) at least 3-4 days/week. Long runs, bike rides,
      swims, gym workouts, yoga, or other athletic activity.
    • Active: Moderate physical activity (increased heart rate/able to talk in
      full sentences) 1-2 days/week. Walks, runs, bike rides, swims, hikes,
      yoga, gym workouts, or other athletic activity.
    • Somewhat Active: Easy to moderate physical activity (slightly increased heart rate/can readily talk or sing) 3 times per month, or less. Walks, runs, swims, hikes, gym workouts, other other athletic activity.
    • Not Active: Very limited physical activity.

Using the key above please select your level of physical activity.

Have you ever had any serious injuries, illnesses, operations, or hospitalizations? Has there been any change in your general health in the past year?

Please explain Recent Medical History

Do you have any physical limitations or impairments? Do you have any balance issues and/or a fear of heights?

If yes, please explain.
Emergency Contact Person

Name and phone number of an emergency contact NOT joining you on this trip.

Name and phone number of an emergency contact NOT joining you on this trip.
Do you have or have you ever had any of the following?

Do you have any severe or life-threatening allergies?

If yes, please explain your severe allergy. And do you carry an epi-pen?

If yes, please use box below to let us know if your asthma is exercise induced, if you'll bring your medication on your trip, and if you've ever been hospitalized.

(arteriosclerosis, angina, COPD)

If you answered 'Yes' to any of the above diseases or conditions please use this box to elaborate. If you have asthma please let us know if your asthma is exercise induced, if you'll bring your medication on your trip, and if you've ever been hospitalized.

Are you taking any medications, over the counter or prescription?

If yes, please list the drug name(s) and indicate the reason for taking each drug.

Do you have any disease, condition or problem not listed above? If yes, please explain.
Gear Checklist

Click SUBMIT to save your form and proceed.