Regitration Form



    Activity

    Activity details






    format: jj.mm.aaaa

    Contact information

    legal representative if minor participant
























    ex: +41 79 123 45 67





    Participant's contact details


    same as contact details

    [group group-participant-name]






    [/group]


    format: jj.mm.aaaa




    (required for clinics where we practice falls)


    Emergency contact person in case of emergency during the activity







    Equipment

    tick what you need

    Harness


    SMLXL













    Climbing level and experience


    What grade does the participant regularly climb without falling:








    Does the participant lead climb?


    Has he been trained for lead climbing?


    nonea little bita lot




    Health information

    Climbing is a physical, highly emotional, risky activity that can take place in a natural environment. In order to ensure the participant's safety as much as possible, we would like to ask you for information about his or her health.
    Important: this information will be treated confidentially.

    → Please indicate at least the health information that may have consequences during the activity.

    → Leave empty otherwise.



    Does the participant currently suffer - or has he/she suffered in the past - from one or more diseases (e.g. asthma, diabetes, epilepsy/convulsions, fungal infections, plantar warts, heart, lung or urinary disorders, hyperactivity, hemophilia, etc.)? If so, which one(s)?




    Does the participant have any allergies (animals, insects, plants, medicines, food, other substances, etc.)? If so, which one(s)?




    Does the participant take any medication during the activity? If so, which ones?


    [group group-multiday]


    Is the member on a diet or allergic to certain foods? If so, which ones?


    [/group]


    Do you have any other useful information to communicate (addictions, stress behaviour, hyperventilation, hyperventilation, disability, somnambulism, low vision, contact lenses or glasses, dental or acoustic apparatus, shoe shapes, bed-wetting, particular habits, comprehension problems, behaviour problems, etc.)?


    Insurances










    Remarks




    See the general conditions (automatic translation by google translate, the French version is authoritative).








    General conditions

    Repatriation insurance

    Cancellation insurance