Participant Information

Private Rock Climbing

    Medical Information

    Who should we contact in case of emergency?

    What is her/his relationship to you?

    Emergency Contact Phone Number

    Do you have diabetes?

    How well is it under control?

    Do you have a history of seizures?

    How well is it under control?

    Do you have heart disease?

    How well is it managed?

    Do you have a history or or currently have asthma?

    If you use an inhaler, will you have it with you?

    Do you have a history of anaphylaxis or allergies?

    If so, will you have an EpiPen or other prescribed medications with you?

    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?

    If so, please explain.

    Are you under the influence of illegal drugs or alcohol?

    Do you have medical insurance?

    If so, who is your provider?

    Equipment Needs

    Do you have a harness?

    If no, what is your waist size?

    Do you have climbing shoes?

    If no, what is your shoe size?

    Do you have a helmet?

    What additional gear, if any, do you own?

    Climbing Experience

    Do you have any previous climbing experience?

    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?

    Do you trad climb?

    What level do you top rope?

    What level do you lead?

    Have you followed a trad or multi pitch route?

    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