HIGH COUNTRY ADVENTURES RESERVATION FORM
Please complete and return along with your non-refundable deposit; the balance is due 30 days before the trip’s starting date.
Mail to: HIGH COUNTRY ADVENTURES
P.O. Box 1404
Choteau, MT 59422
I would like to take the ___________________ backpacking trip from _____ to ______, 200__.
Name: ____________________________________
(Please Print)
Address:______________________________________________________________________________
(Street or Box Number) (City, State, Zip)
E-mail address: ___________________________________________________
Please give us BOTH your work and home telephone numbers: (H) ______________ (W) _____________
Rental Package? Yes ____ No_____
Age: ______Height: ________Weight: ______Blood Pressure:____/____Resting pulse rate:____
Current medications:___________________________________________________________
Are there any health, allergies, or dietary concerns we should know about?
_______________________________________________________________________
Recent backpacking experience:________________________________________________
Contact in case of an emergency:
_______________________________________________________________________
(Name) (Phone numbers) (Relationship)
First-time applicants: what physical activities do you engage in on a regular basis?
__________________________________________________________________________
RELEASE AND ASSUMPTION OF RISKSI UNDERSTAND THAT WILDERNESS TRAVEL MAY BE HAZARDOUS. COMMUNICATIONS TO THE OUTSIDE WORLD ARE LIMITED (NO TWO WAY RADIOS OR TELEPHONES ARE TAKEN). WEATHER AND TRAIL CONDITIONS ARE NOT PREDICTABLE. STEEP TERRAIN WILL BE ENCOUNTERED. I WARRANT THAT I AM IN GOOD HEALTH, AM ABLE TO PERFORM VIGOROUS EXERCISE AND AM ABLE TO TOLERATE THE CONDITIONS THAT MAY BE ENCOUNTERED. I WILL NOT HOLD HIGH COUNTRY ADVENTURES OR ITS AGENTS RESPONSIBLE FOR INJURIES THAT MAY OCCUR ON THE TRIP OR AS A RESULT OF IT.
______________________________________________________________ ________200__
(Signature)