Client-Info — Alpine Exposure

Email

Phone Number

Home Address

Emergency Contact Name

Emergency Contact Number

Height

Weight

Describe your previous backcountry skiing/snowboarding experience

Do you have a history of, ever had, or currently suffer from any health issues or physical injuries

Example: heart disease. knee, shoulder, wrist or foot injuries, concussion or head injury, frostbite or Reynouds Syndrome, altitude sickness, anxiety or depression

Are you taking any medications

If yes, then please describe

Do you have any conditions not listed on this form that could affect your participation in this program?

If yes, please describe

Do you have any food allergies or dietary restrictions?

If yes, please describe

How did you hear about us?

Tell Us About Yourself

Alpine Exposure LLC