Today's Date *
Today's Date
Contact Information
Address *
Phone *
Type "1" in the country code for the US and Canada.
Background Information
Birthdate *
Please describe your climbing or skiing experience that's relevant for this adventure.
If you need to be more verbal, use the Mountain Experience box above.
I recommend solid Intermediate ability level for most adventures.
How do you normally train? Do you play in any organized sports? Do you run, go to the climbing gym, or crossfit? Are you doing anything specific and different for this adventure?
Emergency Contact Information
Emergency contact phone number *
Emergency contact phone number
Type "1" in the country code for the US and Canada
Medical Information
Also, if you have anything else you'd like me to know about your medical or physical condition.
Consider packing a spare set.
This is highly recommended, and in some cases may be required. If you have additional rescue insurance then described here, please let me know in the box above.
Please carry your health insurance information with you!
If so, make sure your emergency contact has originals or notarized copies.
I understand that failing to inform Simmons Mountain Works of relevant physical limitations or medical conditions can create a safety hazard to myself and others, and therefore may result in immediate cancelation of services at any time with no refund of payments made.
If the person above is less than 18 years old - must also match the name of the emergency contact.
Today's Date *
Today's Date
Last thing *
Thanks for filling out this form. I hope it wasn't too painful. Now, just check the box below to show that: