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Adventure Trek Information Form

We look forward to seeing you on this Adventure Trek!

Please fill out the form below at your earliest convenience. This information is necessary so we can ensure a healthy and safe Trek. We have prefilled the information we have on file for your convenience.

Step 1 of 4 - Personal Information

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Booking_id
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Email*
First Name*
Last Name*
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country

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Do you have any of these common food allergies?
Please note: You are responsible for ensuring your meals do not include your allergens/sensitivities.
- Dairy
- Eggs
- Peanuts
- Tree Nuts
- Soy
- Wheat
- Fish
- Shellfish
- No Food Allergies
Please list any food sensitivities or other less common food allergies you have:

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Gender
- Female
- Male
Height
Weight (lbs)
Emergency contact
Emergency contact phone
Doctor name
Doctor phone
Doctor approval
Current medication
Are you afraid of heights?
- Yes
- No
Do you get car sick?
- Yes
- No
Medical History
Please check all that apply
- Elevated blood pressure
- Elevated cholesterol
- Family heart disease
- Smoke cigarettes
- Kidney disease
- Joint Issues
- Angina
- Palpitations
- Shortness of breath
- Heart attack
- Stroke
- Dizzy spells
- Peripheral vascular
- Arterial bypass
- Beta blockers
- Angioplasty
- Lung problems
- Neck or back pain
- Pollen allergies
- Dust allergies
- Depression
- Anxiety
- Mood swings
- Hearing problems
- Vision problems
- Epilepsy
- Type 1 diabetes
- Type 2 diabetes
Do you have any communicable diseases?
Other conditions or notes about your health

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On some Adventure Treks, we secure difficult-to-attain visas for you.
Passport Number
Passport Country
Full Legal Name On Passport
Passport Expiration
MM slash DD slash YYYY
Do you have your travel plans booked?*
Remember: It is your responsibility to arrange transportation to and from the starting and ending points of the Adventure Trek. This information is for our records only.
- Yes
- No
Email info@mountaintrek.com if you have any questions about travel. We will ask for your travel plans again prior to your arrival.
Arrival Airport
Flight Arrival Date
MM slash DD slash YYYY
Flight Arrival Time
Flight Arrival Airline
Flight Arrival Number
Departure Airport
Flight Departure Date
MM slash DD slash YYYY
Flight Departure Time
Flight Departure Airline
Flight Departure Number
Other travel arrangements (trains, boats, etc.)

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Request Brochure

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Phone
This field is for validation purposes and should be left unchanged.

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Email
First Name
Alumni
I am a Mountain Trek Alum
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Comments
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Contact Us

info@mountaintrek.com

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