Backpack Aysen Patagonia March 2019 TRIP AGREEMENT

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Name

Email

Application for Please check for the trip or trips for which this Application applies.

Feb 22- Mar 3, 2019- Cerro Castillo Circuit & San Lorenzo Basecamp Mar 4-Mar 12, 2019- Backpack the Peaks, Lakes and Glaciers of Aysén

Preparedness I understand that this trip requires excellent aerobic conditioning, balance, and the skills and gear to pack appropriately and carry a daypack with confidence for 10-15 miles per day on sometimes very rugged terrain, including steep scree or boulder ascents/descents and moderate exposure. I certify that I will be prepared with the experience, skills, conditioning, and gear to meet the requirements of the trip.

Route I understand that the trek may require me to ford cold swift rivers, cross lakes in a kayak or zodiac and walk on a glacier (under the supervision of experienced guides).

Emergency I understand that emergency evacuation options are limited by terrain and weather so it could be 2 days or more to evacuate me by stretcher to a good medical facility if I am injured or ill.

Accomodation I understand that this trip requires me to provide and carry my own backpack with shelter, sleeping pad, clothing, water and personal gear.

Food I understand that the variety of food available and the ability to meet special dietary preferences may be limited.

Travel Documents I understand that I will be required to hold up to date travel documents and international medical insurance and emergency evacuation insurance for the trip, at my own expense. The evacuation insurance should be sufficient to get me back to the hospital of my choice in the United States.

Team Work I understand that this is a group trip and that participants will look out for and support each other on the trail. Pace, daily start-end times, route and side trips will be driven by the needs of the group and conditions on the ground.

Leadership I understand that safety and well-being of participants comes first and the itinerary and route may change without prior notice based on conditions. While participant input will be valued, the Mountaineers trip leader will be the ultimate decision maker.

Responsibility I understand that the Mountaineers trip leader is not a guide and that I am responsible to know the route and where I am along the way at all times.

Fitness and Medical Conditions I commit to providing a doctor’s certification of medical fitness if requested, and to disclose to the leader and outfitter in advance of the trip about any recent injuries, surgeries, allergies, medications or medical conditions that could impact me on the trip.

Behavior I commit to behave during the trip in a careful and safe manner, to communicate to the leader promptly about any illness or injury, and to put my health and safety and that of my fellow group members first even if this means having to turn around or exit the trip early.

Cancellation Fees I understand that there is a minimum $100 fee if I cancel, plus any non-refundable expenses incurred up to that point.

Participant Signature Please type your full legal name.

Date Signed

Name on Passport Please type your full name as it appears on your passport.

Passport Number

Date of Birth

Nationality

Passport Expiration Date

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Backpack Aysen Patagonia March 2019 TRIP AGREEMENT

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