Be sure and complete the type of expedition you are interested in, and include expedition dates. Also, have information about medical insurance, prescription and/or over the counter medications and allergies available when completing the forms. Once you have submitted both forms you are ready to begin planning for your Adventure.

Note: There are TWO forms to submit on this page!

If you would prefer, you can also PRINT this form to fill it out.

Registration and Health Form

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday / Age:

Height and weight:

T-Shirt Size

Please indicate what size t-shirt you prefer: Adult S, M, L, XL, XXL

Emergency Contact Name

Emergency Contact Phone Number

(###)

###

####

Relationship to You

Expedition Name

Expedition Date

In a word, rate your current physical strength and endurance:

Please describe your daily exercise or other physical conditioning program:

Are there foods you will not or can not eat? Do you have any other special dietary requirements?

Primary doctor's name and phone number:

Medical Insurance Name, Group/Member Number:

Can you swim well?

Yes

Do you smoke?

Yes

Do you wear glasses/contacts?

Yes

Do you have any known allergies (like insect stings, drug or food allergies)? If so, please list severity and type of reaction:

Do you take any prescription medications? If so, please list and explain their purpose:

Do you have a history of heart problems or have you had any recent illnesses, injuries, hospitalizations or operations?

Is there any other information that we should know about you?

Name of Emergency Contact

Expedition Release and Agreement

Each participant must electronically sign and agree to these statements in order to participate in a ReCreation Adventure expedition.

Name

First Name

Last Name

I understand and agree that the ReCreation Adventure Expedition involves certain known risks, including but not limited to, transportation accidents, personal injuries and loss or destruction of my property. I understand and agree that ReCreation Adventures cannot be expected to control all of said risks. In consideration of the benefits I will receive through participating in a ReCreation Adventure Expedition I hereby expressly and knowingly release ReCreation Adventures, its staff and volunteers from any and all claims and causes of action I may have for property damage, personal injury or death sustained by me arising out of any travel or activity conducted by ReCreation Adventures.

I hereby give my consent for any medical treatment that may be required during my participation in a ReCreation Adventure Expedition with the understanding that the cost of any such treatment will be my responsibility.

After you have read each of the policies on the Refund/Cancellation Policies page, please enter your first and last name and the date that you completed this portion of the registration process and submit the form.

Today's date: