Registration & Medical for Morocco

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BOOKING REFERENCE
The booking reference is the surname of the person who has made the booking on behalf of your group.
PERSONAL INFORMATION
Title (Mr, Mrs, etc.)
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of birth*

DD
MM
YYYY
Home Phone
Mobile Phone
E-mail*

NEXT OF KIN
Who we will contact in case of an emergency
Title (Mr, Mrs, etc.)*
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone
Work Phone

EXPERIENCE & FITNESS
Previous Experience
Please provide a brief summary of your mountaineering experience & general fitness.
SPECIAL REQUIREMENTS
Dietary requirements*
MEDICAL STATEMENT
Do you, or have you ever had any of the following medical conditions? If you have, please provide details.*
- Diabetes
- Asthma
- Epilepsy
- Heart disease
- Back injuries
- Allergies (food, insect bite, etc.)
- Drug Allergies
- No issues
- Other
Medical details
If you have stated any conditions above, please provide details here
Medication
Do you require any medication? If yes, please provide details. N.B. It is your responsibility to bring any medication you need and inform the activity leader of where it is kept.

INSURANCE
The Mountain People is is insured against public liability. We require our clients to take out a personal/company policy to cover travel delays, personal injury and loss/damages to possessions, and helicopter evacuation and rescue. Please provide details:
Insurance company*
Policy number
Emergency claims number
PHOTOGRAPHY
The Mountain People may post course photos on its web gallery for viewing by delegates. Occasionally The Mountain People uses photographs taken on courses in its promotional material and website. Please let our instructors know on the day if you would not like your image to be used for either of these purposes.
PARTICIPATION STATEMENT
I accept that The Mountain People is not under any liability whatsoever in respect of loss or damage to personal property not caused by the negligence or default of TMP whilst attending the course. I have had my attention drawn to the information on insurance cover. Participation in adventurous activities entails some risk of injury. TMP staff are trained and appropriately qualified to run activity sessions and will at all times proceed in a manner to limit the risk of injury. However, participants accept that accidents and injury may occur. If you are not sure of the nature of the risks, please contact us to clarify.
Signed*
Date*
Date Format: DD slash MM slash YYYY

BOOKING REFERENCE