2022 Medical Registration Form

All information submitted in this form will be kept confidential. We respect your right to medical privacy, but also ask that you remember that his medical form may be critical for guides, paramedics, and doctors to assist you during a medical emergency.
  • Confidential Online Registration & Medical Form

  • In Case of Emergency – Contact:

  • Participant Physical & Medical Information

    *If under age of 19, liability waiver must be reviewed by parent/guardian.
  • The medical information I have submitted is complete and accurate. If any of my information changes, I will inform Coast Mountain Expeditions ahead of the trip. I agree to follow rules and requests of the trip leaders whose job is to minimize risk and ensure safety. I have read the disclosure information and understand the possible hazards that may be encountered on the trip. I have read the trip outline and physical requirements and I am in good physical condition to participate. I have read the Disclaimer of Liability of Coast Mountain Expeditions. Ltd. and agree to be bound by its terms and conditions. I will sign the liability waiver on arrival and provide guardian/parent consent for any participant under 19 who is traveling in my care.