ROCKY MOUNTAIN SECTION / EDMONTON SECTION

TRIP PARTICIPANT APPLICATION FORM

Please note that this questionnaire will be used to assist us in assessing participants and will be referred to in case of emergency. Its purpose is to give you and us the assurance that your mountain experience is suitable for the trip you want to join. Please note that this application form is the same for all trip participants - whether it is for very easy trips or very difficult ones.

TRIP NAME:  ___Fairy Meadow Summer Camp _______________________________

DATE:  ____August 3-10, 2008______________________________

PERSONAL INFORMATION:

NAME: ____________________________ PHONE #: __________________________

ADDRESS: _____________________________________________________________

E-MAIL: ___________________________  ACC MEMBERSHIP #:________________

ALLERGIES OR MEDICAL CONDITIONS the trip leader should be aware of

_______________________________________________________________________

EMERGENCY CONTACT (Name, Phone Numbers, Relationship)

_______________________________________________________________________

SIMILAR TRIPS DONE IN THE LAST 2 YEARS - CLIMBING, SCRAMBLING, HIKING, SKIIING (Date, Trip Leader or Guide’s Name, Your Role)

______________________________________________________________________________________________________________________________________________

Rocky Mountain Section Reference (Name) ____________________________________

RATE YOUR  1) CURRENT FITNESS LEVEL __________________________

      2) SKILL LEVEL FOR THIS TRIP ________________________

LIST RELEVANT COURSES TAKEN (include course date)

(e.g. First Aid, Rope Rescue, Crevasse Rescue)

_______________________________________________________________________

_______________________________________________________________________

WHEN DID YOU LAST PRACTICE THE SKILLS RELEVANT TO THIS TRIP?

(e.g. crevasse rescue, rope rescue) ______________________________________________________________________________________________________________________________________________

What equipment do you own that is required for this trip? _________________________

_______________________________________________________________________

What equipment do you need to rent? _________________________________________