Participant acknowledgement of accuracy and understanding. By signing this form, I am declaring that, to the best of my knowledge, I have completed the questionnaire accurately. I also understand that by knowingly filling out the form inaccurately, or by withholding pertinent information about my health, I could cause serious harm to myself or others.. I agree to inform my trip leader should there be any changes to my health status prior to the start of the trip. I understand the outing may require vigorous activity that is both physically and mentally demanding in isolated areas without medical facilities. I am fully capable of participating on this trip.
Consent to share confidential information. By signing this form, I authorize the above medical information to be shared with volunteers, representatives, contractors or emergency medical personnel on occasion that emergency treatment is necessary.
Consent to accept aid. By signing this form, I am giving consent and permission for Mountaineers volunteers, representatives, or contractors to provide me with medical care, to transport me to a medical facility or to seek the aid of emergency medical services as deemed appropriate. I further authorize Mountaineers volunteers, representatives, or contractors to render whatever treatment they consider necessary for my health, and I agree to pay all costs associated with that care and transportation.