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MOUNTAIN MADNESS TOURS

11624 93st Edmonton Alberta T5G1C9
Ph:7808859813
Email: info@mountainmadnesstours.com
Website: www.mountainmadnesstours.com

Pre Tour Covid Questionaire

1. I have not travelled outside Canada in the last 14 days.  

I Agree

2. I have not had close contact with a case of COVID-19 in the last 14 days?  

I Agree

3. I do not have any new onset (or worsening) of the following symptoms.
- Fever
- Cough
- Shortness of Breath
- Runny nose
- Sore throat
- Chills
- Painful swwallowing
- Nasal Congestion
- Feeling unwell / Fatigued
- Nausea / Vomiting / Diarrhea
- Unexplained loss of appetite
- Loss of sense of taste or smell
- Muscle / Joint aches
- Headache
- Conjuntivitis (commonly known as pink eye)  

I Agree

If you cannot agree to the above 3 questions we ask that you stay home and not participate in the tour. If this is the case you will be offered a full refund. 

First Participant's Name

First Name*

Last Name*
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*
Second Participant's Signature*
Third Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Today's Date
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*

Relationship*
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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