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Making your ideal adventure come true!!!

COMPLETING THE APPLICATION PROCESS REQUIRES YOU TO FILL OUT BOTH FORMS CORRECTLY AND SUBMIT THEM.

PARTICIPANT MEDICAL FORM

Please carefully read and complete the following form. All information will be held confidential and is in the interest of safety during your course or trip. Answering “yes” to any question does not automatically disqualify anyone from a trip, it only helps the guides to be prepared! If you circle “YES” on any of the following questions, please explain on the space provided below. Do you currently have or do you have a history of:

01. Have you had eye surgery or have an eye condition? *Yes.No.

02. Have you had or do you have bleeding or blood disorders? *Yes.No.

03. Have you had or do you have eating disorders? *Yes.No.

04. Have you had or do you have hepatitis or other liver disease? *Yes.No.

05. Have you had or do you have neurological problems (epilepsy, seizures)? *Yes.No.

06. Have you had or are you having episodes of dizziness or fainting? *Yes.No.

07. Do you have treatment or medication for menstrual cramps? *Yes.No.

08. Have you had or do you have urinary or reproductive tract disorders? *Yes.No.

09. Have you had or do you have any current or previous cardiovascular disease or other cardiac problems? *Yes.No.

10. Have you had a family history of cardiac disease? *Yes.No.

11. Have you had or do you have gastrointestinal disorders? *Yes.No.

12. Do you have Diabetes? *Yes.No.

13. Do you have hypertension? *Yes.No.

14. Have you had frostbite or frostnip? *Yes.No.

15. Have you had Acute Mountain Sickness or a history of problems at altitude? *Yes.No.

16. Have you had heat stroke or another heat-related illness? *Yes.No.

17. Have you had or do you have high blood pressure? *Yes.No.

18. Have you had or do you have Obesity? *Yes.No.

19. Are you a smoker? *Yes.No.

20. Have you had or do you have respiratory problems (Asthma)? *Yes.No.

21. Have you had or do you have unexplained chest pain, shortness of breath, or palpitations? *Yes.No.

22. Have you had or do you have high blood cholesterol? *Yes.No.

23. Have you had or do you have injuries to your knee, hip, ankle, shoulder, elbow, wrist, arm or back? *Yes.No.

24. Do you have any dietary preferences (i.e. vegetarian or vegan)? *Yes.No.

25. Have you had or do you have any food allergies (celiac or lactose intolerant)? *Yes.No.

26. Have you had or do you have allergies to medications (i.e. painkillers, anesthesia, antibiotics, non-steroidal anti-inflammatory drugs or NSAID)? *Yes.No.

27. Have you had or do you have any other type of allergy (i.e. plants, animals, insects)? *Yes.No.

28. Are you taking any medications (i.e. drugs, nutritional supplements, vitamins, minerals)? *Yes.No.

29. Do you drink alcoholic beverages? *Yes.No.

30. what blood type do you have? *A+A-B+B-AB+AB-O+O-

If you answered “yes” to any of the above, please explain below – include dates of last occurrence.

Terms & Conditions. *

Yes, I agree with the Terms & Conditions.

Please do not fill in this field.

PARTICIPANT INFORMATION FORM

Please take the necessary time to read and complete the form below.

All information will be held confidential.

These data are crucial so that our guides can know you, organize reservations, logistics, and establish timely and prompt communication.

All for the benefit of the service we provide you and in order to follow our principles of keeping you safe, generating the best experience and doing our best to achieve your goals.

Personal information.

Aplicant's Name. *

Male.Female.

Height. *

Weight. *

Date of birth. *

Age. *

Passport. *

Ocupation.

Email. *

Whatsapp.

Cell phone. *

Mail address.

Emergency contact.

Full name. *

Relationship.

Whatsapp.

Cell phone. *

Email. *

Mail address.

Trip information.

Trip you are applying for: *

Departure date. *

Return date. *

Insurance information.

Trip cancellation insurance company. *

Policy number. *

Phone number. *

Rescue insurance company. *

Policy number. *

Phone number. *

Medical insurance company. *

Policy number. *

Phone number. *

Previous experience.

Mention if you have had previous experiences in high altitude mountains and their results:

Consent *

Yes, I agree with the Terms & Conditions.

Please do not fill in this field.

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Full name. *

Email. *

Terms & Conditions. *

Yes, I agree with the Terms & Conditions.

Please do not fill in this field.

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Trekking

Cedros - Alpamayo - Santa Cruz.
Huayhuash.

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Alpamayo - Quitaraju - Huarapasca.
Chopicalqui - Yanapaccha - Pisco - Mateo.
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