Alaska Guide Collective Trip Application
Please fill out one form per guest.
Email address *
Trip start date *
Add the correct, month, day and YEAR trip starts in
MM
/
DD
/
YYYY
Your guide name *
Required
Trip name *
Group name or the last name of your groups organizer
Your answer
First and last name *
Your answer
Preferred name
Your answer
Street address *
Your answer
City *
Your answer
State or country *
Your answer
Zip Code *
Your answer
Phone number *
Your answer
Occupation
Your answer
Outdoor experience related to this trip *
Your answer
Summarize your exercise schedule and fitness level *
Your answer
MEDICAL INFORMATION
Your medical information provided is held private, completely confidential. Please be honest and complete with your answers. Your information does not inhibit the participation on trips. For the remote nature and often strenuous activity on trips it is important that we have full details of any medical conditions, past injuries or prescription drugs used. Your information is held professionally by the guide and held by the administration.
Gender *
Age *
Your answer
Height *
Your answer
Weight *
Your answer
Do you have asthma? If so, please explain. *
Your answer
Do you have diabetes? If so, please explain. *
Your answer
Do you have allergies? If so, please explain. *
Your answer
Do you have heart disease? If so, please explain. *
Your answer
Do you have seizures? If so, please explain. *
Your answer
Have you had altitude illness? If so, please explain. *
Your answer
Are you taking any medications? If so, please list. *
Your answer
Any other medical or physical conditions that may affect your ability to participate in this trip? *
Your answer
I assure that all the above medical information is accurate. *
Required
EMERGENCY CONTACT INFO
Emergency contact name *
Your answer
Emergency contact relation *
Your answer
Emergency contact phone number *
Your answer
Emergency contact secondary phone
Your answer
Emergency contact email *
Your answer
I have read and agree to the payment and cancellation policy. *
Required
Rescue and trip insurance *
Details in Reservation and Cancellation Policy
Required
I understand I am responsible for my own transportation. *
AGC representatives are not able to provide transportation.
Required
Photo release *
Do you grant AGC the use of photos taken of you during the trip for website, marketing or other purposes?
Required
SKI TRIP QUESTIONS
Mode of travel for ski or snowboard trips
Ski or snowboard skill level
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