First Name *

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell *

Cell

(###)

###

####

TRANSPORTATION

*ALL ARE RESPONSIBLE FOR THEIR OWN TRANSPORTATION TO AND FROM TRIP START, BUT WE'LL HELP COORDINATE CARPOOLS OR SHARED RENTALS FOR FOLKS LEAVING FROM THE SAME AREA. PASSENGERS WILL CONTRIBUTE TO OWNERS/DRIVERS TO COVER THE COST OF GAS AND WEAR & TEAR, OR EVENLY SPLIT THE COST OF A RENTAL.

Do you have a car/insurance/license and are you willing to drive others?

If you answered 'Yes', how many passenger seats are available in your car, not including you (the driver)?

GEAR

Please indicate which of the following pieces of equipment you need supplied by Mountain Sea *

If you own a lightweight backpacking tent, sleeping bag, sleeping pad, water filter, bear can (for Sierras trips) or headlamp, please bring them! If borrowing a Mountain Sea sleeping bag, you'll be provided with your own sleeping bag liner. Prices based on entire weekend.

Tent ($35)

Sleeping Bag ($25)

Sleeping Pad ($15)

Headlamp ($15)

Bear Can ($15)

Hiking poles (personal preference) ($10)

I HAVE EVERYTHING I NEED THANKS!

What is your height/weight approximately (used for sizing) *

HEALTH and SAFETY

Birthday *

Birthday

YYYY

Emergency Contact *

Emergency Contact

(###)

###

####

Do you have any allergies? If yes, what's your allergic response, and what do you do to mitigate your symptoms? Please be as detailed as possible! *

a. I'm allergic to pollen, and I get sneezy and runny nosed. I take Claritin daily. b. I'm allergic to bees, and will experience anaphylactic shock if stung. I bring epi pens everywhere I go. c. I cannot eat nor be anywhere NEAR peanuts! My reaction is anaphylaxis, so I always carry an epi pen. Pack any medications you take to mitigate the effects of your allergies.

Dietary Restrictions *

Ex.: vegan, dairy allergy, peanut allergy, etc. Please indicate a restriction if it poses a health issue for you, rather than an inclination.

Do you have any medical issues that might impact you on this trip? *

Diabetes, heart condition, recent surgery, pregnancy, etc.

What prescription drugs do you take? *

Please specify the drug name, and be sure to bring them with you on the trip. If none, put "none"

Do you have Travel Insurance for you trip? *

Yes

If you checked "yes" above for insurance, who is your provider?

If you have a travel insurance policy, is it "cancel anytime?"

Yes

OTHER

Do you have previous backpacking experience? *

Yes, I have been on 10+ overnight backpacking trips

Yes, >10 overnight backpacking trips

No backpacking trips, just car camping

I've never been camping or backpacking

What is your morning beverage of choice? *

...And your evening beverage of choice? *

Write a one-sentence bio! We'll use it to introduce you to the group before the trip. *

Caitlin is the founder of Mountain Sea and loves hunting for wild food while singing a tune with her friends...

How did you hear about Mountain Sea Adventures? *

Anything else you want to mention?

BACKPACKING INTAKE FORM