BOOKINGS | ACONCAGUA EXPEDITIONS

IMPORTANT

When you forward your booking form to us, it is understood by ACONCAGUA MOUNTAIN GUIDES that you acknowledge and agree to all the terms and conditions set out in the GENERAL OPERATION CONDITIONS. Also, it is understood by ACONCAGUA MOUNTAIN GUIDES that THE INFORMATION IN THIS FORM IS CURRENT AND ACCURATE.

In case you come with a friend or a relative please, fill in a different form per member. Thank you for your time!!

1- Personal Information

First Name (as in the passport)*

Last Surname (as in the Passport)*

Select Nationality

Male/Female

Passport Number

Born Date

Occupation

E-mail

Present Address

Telephone number (Area Code / Your Phone)

In case of EMERGENCY contact

Emergency contact’s telephone number (Area Code / Phone)

Emergency contact’s e-mail



2- Service Information

Service you will take

Route you will take

Starting Date of the Program

Duration

3- Questionnaire on physical condition

The following questions are extremely important to guarantee an excellent service.It is absolutely essential that you complete with updated and truthful information.


How tall are you?(in centimeters)

What is your weight?

What is your blood type?

What is your normal blood pressure? (minimum and maximum values)

Are you undergoing any medical, psychological or psychiatric treatment?


Do you take any medicine on a regular basis?


Are you allergic?



Have you ever suffered from any of the following conditions: asthma, diabetes, heart disease, epilepsy?

Have you ever suffered from any other condition we should be informed about?


Have you ever suffered from cerebral or lung edema?


Have you ever had any problem related to altitude in any of your previous experiences?


Do you suffer from any special condition on your knees, back or chest?
 

Do you suffer from any physical impediment or condition we need to know?


Do you have any restricted diet?


Do you smoke? How many cigarettes and how often?


Are you pregnant?(only if you are a woman)

Do you have any regular fitness program? What kind of activity?


Please, write a summary of your outdoor experience

I DECLARE THAT THE INFORMATION IN THIS FORM IS CURRENT AND ACCURATE.
I accept the General Operation Conditions