Who should we contact in case of emergency?
What is her/his relationship to you?
Emergency Contact Phone Number
Do you have diabetes?---YesNo
How well is it under control?
Do you have a history of seizures?---YesNo
Do you have heart disease?---YesNo
How well is it managed?
Do you have a history or or currently have asthma?---YesNo
If you use an inhaler, will you have it with you?---YesNo
Do you have a history of anaphylaxis or allergies?---YesNo
If so, will you have an EpiPen or other prescribed medications with you?---YesNo
Do you have relevant musculoskeletal injuries or related surgeries? If so, please explain.
Do you have problems with vision or hearing? If so, please explain.
Do you have any other health issues that would prevent you from fully participating in activities provided by Vertical Voyages?---YesNo
If so, please explain.
Are you under the influence of illegal drugs or alcohol?---YesNo
Do you have medical insurance?---YesNo
If so, who is your provider?
Do you have a harness?---YesNo
If no, what is your waist size?
Do you have climbing shoes?---YesNo
If no, what is your shoe size?
Do you have a helmet?---YesNo
What additional gear, if any, do you own?
Do you have any previous climbing experience?---YesNo
If so, how many years have you been climbing?
Which of the following best describe(s) your previous climbing experience? Select all that apply.None or Very LimitedGym ClimbingOutdoor ClimbingRappellingTop Rope BelayLead BelayMulti-PitchOther
If other, please describe.
Do you sport lead?---YesNo
Do you trad climb?---YesNo
What level do you top rope?
What level do you lead?
Have you followed a trad or multi pitch route?---YesNo
What do you want to learn in your course? Tell us some of your climbing goals.
I have read and understood all of the above questions and answered them truthfully.I Agree