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Participant Agreement, Release and Assumption of Risk

In consideration of the services of Alaska Avalanche School, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "AAS"), I hereby agree to release, indemnify, and discharge AAS, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in an avalanche training course entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. Participation in all in-person courses hosted by the Alaska Avalanche School also poses similar risks as interacting with society at large, including contracting communicable diseases, such as COVID-19. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: falling, temperature exposure (hypothermia, frostbite, frostnip, sunburn), collision, striking obstructions or other persons, unsafe speed of travel for conditions or experience, equipment failure, failure to wear protective clothing, elevation changes, weather conditions including electrical storms, avalanches and unfavorable snow conditions. Furthermore, AAS employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's health status, fitness, or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless AAS from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of AAS's equipment or facilities, including any such claims which allege negligent acts or omissions of AAS.

4. Should AAS or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

6. In the event that I file a lawsuit against AAS, I agree to do so solely in the state of Alaska, and I further agree that the substantive law of Alaska shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against AAS on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

November 30, 2021

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18) In consideration of ("Minor") being permitted by AAS to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless AAS from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Pre-Trip Medical History

The environment and physical requirements of courses provided by the Alaska Avalanche School requires that participants be healthy and physically fit. The information provided on this form is held confidentially. Please answer the questions honestly - a history of a medical illness or traumatic injury will not be cause to exclude a participant from a course: however, this information is imperative to properly prepare for any contingencies. In the event you are involved in an accident or medical emergency, your history form will be attached to an incident report and will be passed along to medical personnel. Please alert the AAS staff of any changes that occur prior to the start of your program. If AAS has any follow up questions for you, or if we would like clarification from you, an AAS representative might contact you prior to the start of the course. This is for your health and safety.

Have you been hospitalized in the last 12 months? Or do you currently have any ongoing medical condition for which you are under the care of a medical provider?*
No
Yes

If yes, please explain.
Are you taking any medications for this, either daily or as needed? (include inhalers and over the counter medications).*
No
Yes

If yes, please explain.
If you currently have any of the conditions identified below, please check the box:*
No Medical Conditions
Epilepsy or a seizure disorder
Diabetes
Allergies
Asthma or chronic respiratory illness
High blood pressure
Frostbite or Reynauds
Cardiac disease (including angina, heart failure, palpitations, rhythm problems)
Any other illness or condition that may affect your well-being during this course.
Mask usage is an integral part of our risk reduction strategy for in-person courses this season. If you are unable to tolerate wearing a mask you should delay your attendance until your condition changes or the requirement is removed. We recognize that wearing a face-covering or mask for extended periods of time is not feasible for everyone. Can you tolerate wearing a mask outdoors when social distancing is not possible?*
Yes- I will bring a filtered mask.
No- I will not wear a mask.
People who are at higher risk for severe illness from COVID-19 as defined by the Centers for Disease Control (CDC) should carefully consider, in conjunction with their health care provider, whether to attend an avalanche course at this time. Do you have any conditions that put you in this higher risk category?*
No
Yes- I am at high risk for severe Covid

Please list any allergies to medications or food. Include the reaction you had. Please include food restrictions here.
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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