MEDICAL FORM

Hello fellow adventurer, Welcome on board! please fill out the medical form

Please enable JavaScript in your browser to complete this form.

Personal Information:

First Name *

Last Name *

Emergency Contact Details: *

First

Last

Emergency Contact Phone: *

Email *

Date of Birth *

DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Phone *

Gender *Select optionMaleFemale

Nationality *Select optionAmericanBritishCanadianAustralianIndianChineseJapaneseGermanFrenchItalianSpanishBrazilianMexicanRussianSouth AfricanKoreanSaudi ArabianTurkishNigerianEgyptianDutchSwedishNorwegianDanishFinnishBelgianSwissAustrianGreekPortugueseThaiVietnameseFilipinoIndonesianMalaysianSingaporeanNew ZealanderArgentinianChileanColombianPeruvianCubanIraqiIranianPalestinianAfghanPakistaniBangladeshiSri LankanNepaleseKazakhUkrainianRomanianHungarianCzechSlovakBulgarianCroatianSerbianSlovenianEstonianLatvianLithuanianMalteseIcelandicJamaicanTrinidadianBarbadianHaitianDominicanPuerto RicanPanamanianCosta RicanSalvadoranGuatemalanNicaraguanHonduranChileanEcuadorianVenezuelanBolivianParaguayanUruguayanKuwaitiEmiratiQatariOmaniJordanianLebaneseSyrianYemeni

Passport Number *

Please upload a copy of your passport: *

Click or drag a file to this area to upload.

Have you ever been on a Multi-day hiking trip? *

• Yes
• No

If yes, please mention where and when

Do you usually go on short hiking trips? *

• Yes, frequently
• Yes, from time to time
• No

What is the group size that you usually hike with? *

• Solo
• With a small group of friends
• With big groups where i don't know everyone

How do you describe best your fitness level? *

• Perfect
• Can be better
• Not good at all

Can you walk for 6 to 7 hours a day, for multiple days in a row? *

• Yes, easily
• Yes, but it would be tiring for me
• No, can't do it

The adventure that I want to be part of *Winter Womderland Adventure TourAnnapurna Base Camp TrekEverest Base Camp TrekKilimanjaro Summit TrekSardinia Multi-Adventure TourHigh Tatras trekking adventureAlbania Multi-Adventure TourMont Valley Adventure TourLe Tour du Mont BlancKyrgyzstan Multi-adventure Tour

Please confirm that you fully understand everything related to the adventure including, but not limited to: level of difficulty, level of fitness required, risks involved, equipment needed, etc... *

• I confirm

Have you had any recent operations? *

• Yes
• No

If yes, please specify type and date of operation:

Do you have any of the following medical conditions: *

• Diabetes
• Heart Problems
• Hypertension
• Respiratory problems
• None of the above

If yes, please specify type and condition:

Do you have any of the following medical conditions: "Allergies - including food" *

• Yes
• No

If yes, please specify type and condition:

Do you have any of the following medical conditions: "Respiratory problems like asthma or shortness of breath or..." *

• Yes
• No

Did you recently have any severe injury in muscles, joints or bones? *

• Yes
• No

If yes, please specify:

Do you take any medication? *

• Yes
• No

If yes, please specify name and dosage:

Please state any other medical condition that we need to know about and that might affect your performance or put you in risk during the trek:

• I confirm that I was well informed about the difficulty level of the trek and the level of fitness needed for the program by the company “The Sports Guru”
• I fully understand the program, difficulty level and the fitness level required for the trip and I confirm that I am physically and mentally able to be part of it.
• I fully understand and accept all the potential risks of the trip and I release the company “The Sports Guru” and its team from any liability that might occur as a result of these risks.
• I fully understand and confirm that the company “The Sports Guru” and its team has the discretion at any time of the expedition to determine if any client/s need to descend or if anyone is not allowed to go above any camp for any reason, etc. This is particularly regarding health, fitness or technical ability issues of the client/s, weather, route conditions and group dynamics but not limited to the above.
• I fully understand that there are conditions beyond the capacity of the company “The Sports Guru” and the team to control during the expedition, which might include but is not limited to: Supply and type of available food as well as sanitary and hygienic conditions during the expedition.
• The cost due to loss of equipment used for the purpose of the expedition given by the company “The Sports Guru” and that had to be returned by the client shall be paid by the client.
• I release the company “The Sports Guru” from any liability and financial consequences which result from the change of air connections, losses due to actions of airline operators or operators of other means of transport.
• I release the company “The Sports Guru” from liability for any lost or stolen equipment during the expedition.
• I release the company “The Sports Guru” from any liability if the target destination is not reached (In case of unexpected events that would introduce a risk to any of the participants).
• I consent that I need to come prepared with all the required equipment for the expedition and use appropriate equipment determined by the team at any stage of the expedition.
• I consent that I need to have adequate medical & travel insurance covering the whole duration of the trip and any accident that might happen on high altitude, on and off the trek.
• I consent that I need to get basic medical tests and consult my physician for approval prior to the expedition, especially in the presence of chronic diseases.
• I consent that the team leader of the expedition, representing the company “The Sports Guru”, will have basic medical first aid kit. Any medication related to a specific medical condition shall be brought by the client.
• I consent that the expedition is having place in a remote area and evacuation procedures “in case of any emergency” might take some time (and is solely covered by the client himself and not the company)
• I consent that I have to inform the company “The Sports Guru” in case of any medical issue ahead of and/or during the expedition.

*

• I confirm that I have read and fully understand the points outlined in the above disclaimer, I approve them and agree to abide by them.
• I confirm that all the information provided in the registration and medical form are adequate and correct
• I consent to the use of the personal information I have provided in this form for purposes related to the trip.

Submit