MEDICAL QUESTIONNAIRE

It is important that we have all necessary medical information to ensure a safe and exciting Adventure for you and your fellow participants. Please answer the following questions to the best of your ability. Attempting adventure activities with a pre-existing injury or other physical and/or mental health condition can be dangerous to yourself and your fellow adventurers.


Name *
Name
Q1: Are you currently taking any medications? *
Q2: Do you currently have—or have you ever had—any heart problems or taken any heart medications? *
Q3: Do you have any medical conditions such as allergies, asthma, diabetes, recent operations, or injuries? *
Q4: Do you have any allergies or reactions to medications? *
Q5: Do you currently have—or have you ever had—any medical conditions or injuries that may be aggravated by this activity or may interfere with your ability to complete the program? (Ex: Shortness of
 breath, pregnancy, dizziness, asthma, emphysema, seizure disorders, diabetes, etc.) *
Q6: Do you currently have—or have you ever had—any mental health issues that may interfere with your ability to complete the program? (Ex: Depression, anxiety disorder, etc.)
Q7: Do you currently have—or have you ever had—any physical limitations that would interfere with performance of this activity? (Ex: broken bones, sprains, or other temporary conditions.) *
Q8: Do you have any special dietary restrictions or preferences? *
What is your current level of physical activity & fitness? *
Electronic Signature
Electronic Signature
By typing my name in the space below, I certify that all of the above information is true and accurate to the best of my knowledge.

Click the button below to download our Medical Questionnaire.