Booking & Medical Form

    Name *

    First Name

    Last Name

    Email Address *

    Your Tour *

    Tour Dates *

    Date of Birth *

    dd/mm/yyyy

    Gender *

    Prinicipal Health Care Plan *

    Prinicipal Health Care Plan # *

    Extended Insurance

    Extended Insurance #

    Your Doctor's Name *

    Doctor's Phone Number *

    Emergency Contact *

    Emergency Contact Phone *

    Emergency Contact Relation

    Allergies *

    Please list any allergies, including food allergies (not preferences), bug bites, medications etc. Put none if no allergies.

    Medications *

    Please list any medications you are taking, including prescription, non-prescription and nutritional supplements.

    Last Tetanus Immunization

    Your Health *

    Please describe your overall health as well as you can.

    Chronic Conditions *

    Do you see a Doctor regularly for any chronic conditions? If yes, please explain.

    Past Surgeries, Injuries, Hospitalizations *

    Please list any past surgeries, significant injuries and hospitalizations.

    If Female, Are You Pregnant?

    Please Check All That Apply

    Please describe below.

    Please Describe Any Above Conditions *

    Have You Ever Experienced Cardiac Arrest or Heart Attack

    Please Rate Your Fitness *

    This section requires you to read our Technical Skills & Fitness Levels Section to determine your level of physical fitness and technical skill level.
    Please refer to our rating system before entering the below questionnaire. It is very important for us to have an understanding of your level of riding skills and your fitness levels.

    Technical skills *

    Please Rate Your Swimming Ability

    Physical Limitations *

    Would you or you Doctor say you have any significant physical limitations?

    Anything Else That May Help Us?

    Feel free to tell us anything else you feel might help.

    Diet

    Please describe any dietary restrictions. We will do our best to suit your needs. Feel free to include your favourite kind of foods.

    Tell Us A Bit About Your Mountain Biking Experience

    Please describe how long you have been MTBiking for, the trails you are used to riding, any destinations in the world you have ridden in, and your general skills and fitness levels.

    I have Read The Skills & Fitness Rating For This Ride