Medical and personal information
All participants to any outdoor activities or trip to the Himalayas organized by Himalayan Ecotourism must fill in and submit this form.
Email address *
Group name (the first name of the person who contacted us in the first place) *
Your answer
Name of participant *
Your answer
Sex *
Your answer
Date of birth *
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DD
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Height (cm) *
Your answer
Weight (kg) *
Your answer
Food habits *
Mobile number
Your answer
Have you ever participated in a multi-day trek ? If yes where, for how many days and the altitude gained ? *
Your answer
Did you encounter any altitude related problems on your previous travel/treks ? *
How will you rate your physical fitness on a scale from 0 to 10 ? *
Fitness rating table
0 to 2 You have a sedentary way of life. A little physical effort will leave you out of breath. You know you have a weak stamina.
2 to 4 You have a sedentary way of life but you know that you have some physical potentials. Your body is not used to prolonged physical effort but you don't mind walking for about 2 hours on easy paths with gentle slopes.
4 to 6 You may still have a sedentary way of life but you are physically fit. You don't miss an occasion to go on foot or by cycle. You can run for 10 minutes without problems and you can challenge a lift by climbing on foot a three story stairs with speed. You are not in the best shape but you feel confident in most of the situations where your body will be challenged. In short you have an average fitness.
6 to 8 Even if you work in an office you regularly do sport. Physical activities are an important part of your life. You like to surpass yourself by participating in a race, for instance. Prolonged physical efforts in harsh conditions do not scare you.
8 to 10 You are very sporty. You have already tested your body capacities in a challenging mountain environment for several days, at a high altitude. You are confident that you have a very strong stamina to face the unpredictable.

Note : On the website all trek ratings are from 0 to 100. Just multiply your above rating by 10 to know where you are.

Do you suffer from any allergy to food/medicines/other? If yes please mention. *
Your answer
Do you have chronic illness like diabetes, asthma, epilepsy, heart problems, etc.? If so, please give the details. *
Your answer
Please mention any previous illness, injuries or any operation undergone during the past 6 months. *
Your answer
Please mention any other information related to your health that would be useful to us to plan your trip or in the case of emergencies.
Your answer
Emergency contact information
Please share the details of the person to contact in case of emergency.
Name of contact *
Your answer
Relationship *
Your answer
Mobile number *
Your answer
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