Guest Medical Information | At The Water's Edge Adventures

Name:

Email

Pregnancy

Unfortunately, we are unable to accommodate those who are more than 3 months pregnant. Please note that our standard cancellation policy applies should we be unable to accommodate you for this reason.

Yes, I acknowledge understanding of this restriction and the cancellation terms.

Food allergies

Please check the boxes to inform us of any food allergies.

No, I do not have any food allergies.
Yes, I do have food allergies.
Yes, I have life-threatening food allergies.

For each allergy, please describe your tolerance, symptoms, severity, and treatment. Please detail to what extent small quantities or cross contamination is an issue.

If you have life-threatening food allergies that have not been already discussed and approved by us, please contact us immediately as we may not be able to accomodate you on this tour.

Do you carry an EpiPen or equivalent?

Yes
No

Food preference

Due to the complexity of preparing multiple meals, space constraints in kayaks, limitations on cooking equipment in our remote wilderness environment, and the impact to others on the tour, we can only accommodate the dietary preferences listed here.

I am an omnivore (eats most foods).
I am a pescatarian (vegetarian that eats fish).
I am a vegetarian (eggs and dairy are okay).

My tetanus vaccination is current.

We stongly recommend a current tetanus vaccination. Tetanus is a form of bacteria that can be found in soil, dust, and animal feces. It can enter the body through cuts and wounds. Tetanus affects your nervous system and causes painful muscle contractions, particularly your jaw and neck muscles and can affect your ability to breathe. It can be life-threatening. The tetanus vaccine protects against the disease. Our tours operate in a remote wilderness environment where medical attention is often hours away and evacuation costs can range from $400-$1000. Should your tetanus vaccination not be current while on our tour, you will be responsible for any evacuation costs that may be incurred. Should you not get the vaccination before your tour date, we will require your initals accepting any potential risk and charges.

Yes
No

Do you have any non-food allergies?

Yes
No

Please detail your non-food allergies, symptoms, severity, and treatment.

Do you carry an EpiPen or equivalent?

Yes
No

Do you have diabetes?

Yes, type I
Yes, type II
No

How do you control it? Does your medication require refrigeration?

Do you have any chronic conditions or illnesses? (High blood pressure, asthma, seizures, etc.)

Yes
No

Please specify what, severity, effects, and medication.

Have you been under the care of a medical professional within the past 12 months?

Yes
No

Please specify why.

Are you taking any medication?

Yes
No

Please specify what and why.

I have previously suffered or currently suffer from:

Arm, elbow, wrist, or hand issues
Back, neck, or shoulder issues
Hip, leg, knee, ankle, or foot issues
None of the above

Please detail the recency, cause, severity, and prognosis.

Please provide details of any other issues that may impair your ability to paddle and navigate rough or steep terrain. Please include details on hearing or sight issues and any electrical devices you need to wear.

Please tell us about your previous kayaking experience.

Some on lakes & rivers
Some on the ocean
Have taken whitewater training
Have taken sea kayaking training
None of the above

Please tell us about your previous camping experience.

Some at campgrounds & parks
Some backcountry camping
Lots of wilderness camping
None of the above

Medical/travel insurance provider

Medical/travel insurance identifier

Emergency contact name:

Emergency contact relationship:

Emergency contact phone:

Emergency contact alternate contact method:

I am over 19 or this form has been completed by a parent or legal guardian. All information provided is true and accurate to the best of my knowledge. Should any changes occur prior to or during the trip, I will make it known to At the Water's Edge Adventures.

Yes, I agree