Client Information Form Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Age Occupation How did you hear about us? Option 1 Option 2 Group Name First and Last Name of Group Leader Planned Activity * Course Guided Ski/Snowboard Guided Snowmobile Hut Rental Experience with this activity Activity Start date MM DD YYYY Activity End Date MM DD YYYY Equipment Needed Health * Physical Condition excellent good fair poor What is your normal exercise schedule per week? What activities, how often, duration etc: * Weight Height Medications Allergies Relevant Medical Information recent surgery, prior injuries etc Emergency Contact Information * First Name Last Name Phone (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country I agree that all the information above is correct * I agree Thank you!
