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MEDICAL INFORMATION

Please answer each question using the fields below. Your signature/check mark on this form certifies that your statements are true. Please note that medical information will be shared with your guides to assist with any health related issues while on your course or expedition. Signing this questions indicates you comply and understand the physical requirements for this program.

Please list any operations or illnesses you have had in the past or have in the present.

Please list all medications being taken during the trip and reason for medication

List any and all food or medication allergies:

Please list all dietary restrictions:

Do you feel physically ready for this trip?

In Case Of Emergency Please Notify

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