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Points North Heli Adventures Client Intake Form

Welcome to the Points North Heli Adventures Participant Information Form.   This intake information will help us guide and improve your experience with PNH.  Please fill all fields to the best of your abilities.

By signing this, I understand that PNH reserves the right to take photographic or video recordings of any of its trips. I hereby approve PNH or third parties engaged in joint marketing to use any such media for promotional and/or commercial purposes for this trip and any prior or future trips with PNH without any notice or remuneration to me. I hereby assign all right, title, and interest I may have in any media in which my name or likeness might be used to PNH. I certify that all the statements provided by me herein are true and I agree to be bound by terms contained therein.      

 

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Do you have a medical condition OR are you taking any medications?
Yes/No*
Yes
No

If Yes, please describe: 


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Any known allergies or dietary requirements (peanuts, gluten, medications, latex, etc.)?
Yes/No*
Yes
No

If Yes, please describe:
Rider Information
Type of Rider*
Skier
Snowboarder
Other

Your Weight *

Gender *

Age *

Ability (Scale of 1-10) *
Have you ever been heli-skiing/boarding before?*
Yes
No

If Yes, when and where?

Any other guests with whom you would like to ski/snowboard? (Please note, we also have these notes in your reservation):
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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