Registration Form

Trip Registration and Release Form

Registration and Release Form

Step 1 of 6

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Name as it reads on your passport*
First Last
Hidden
I have submitted my PASSPORT NUMBER, PASSPORT EXPIRATION DATE, and an IMAGE OF MY PASSPORT to Mountain Spirits.*
- Yes
- No
Passport Number*
Passport Expiration Date*
MM slash DD slash YYYY
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth:*
MM slash DD slash YYYY
Height*
Weight*
Hidden
Have you been vaccinated?
- Yes
- No
Hidden
Have you submitted a copy of your vaccination card?
- Yes
- No
Hidden
Please upload a copy of your vaccination card
Max. file size: 1 MB.
Name of Emergency Contact #1:*
Phone Number of Emergency Contact #1*
Name of Emergency Contact #2:*
Phone Number of Emergency Contact #2*

Insurance Information
Medical Insurance:*
Policy Number*
Traveler's Insurance:*
Policy Number*
Mountain Spirits Cancellation Policy
*Deposit for Trip Non Refundable *Balance of Trip Refundable only when specified: Custom Trips are non-refundable (Custom Trips are those we design for you & your group only) Trips open to public sign ups are partially refundable up to 120 days prior to departure *PURCHASE TRAVEL INSURANCE when signing up and making deposits!
I have read and understand the cancellation policy*
- Yes

Travel Information
Arrival Information*
Arrival Date Time Airline Flight#
Departure Information*
Departure Date Time Airline Flight#
Accommodations
I am traveling with:*
- Adults
- Children
- Both
Please list each adult traveling with you (Click the + sign to add more people)
First name Last Name
Please list each child traveling with you (Click the + sign to add more people)
First name Last name
Please list each child and adult traveling with you (Click the + sign to add more people)
Please enter "Child" or "Adult" First name Last name
*
- I would like to share accommodations with:
- I would like single accommodations (requires additional charge)
Name
First Last
Signature*

TRIP PARTICIPANT’S RESPONSIBILITY ~ please read and initial
Trip participants are responsible for any expenses incurred for either having to leave the trip early or for trip schedule being changed and/or delayed (i.e. departure) due to weather and/or other unforeseen circumstances.
Initial:*
Trip participants are responsible for selecting a trip appropriate to their abilities and are held responsible for being in sufficient good health to undertake the trip.
Initial:*
Trip participants are requested to be well informed of current State Department travel bulletins and/or travel warnings: www.travel.state.gov/travel_warnings.html
Initial:*

MEDICAL QUESTIONNAIRE
Please understand that it is required as a trip participant that you advise Mountain Spirits of any existing physical or medical condition that might require attention or that will hinder your ability to safely participate in a trekking trip.
Please fill out information below (IN LAYMAN”S TERMS). This will help to alert us to any special dietary or medical conditions we should be aware of. This information will be kept confidential.
Are you taking any medication?*
- Yes
- No
Name of Medication:
Describe medical condition:
Are you allergic to any foods, medicines or other allergens?*
- Yes
- No
Please List:
Have you ever had an anaphylactic allergic reaction?*
- Yes
- No
To What?
Do you carry an EPI pen or similar product?*
- Yes
- No
Do you have any current medical conditions?*
- Yes
- No
Describe Conditions:
DIET
Do you have dietary restrictions or requests?*
- Yes
- No
List
I understand my responsibilities as a Trip Participant and I certify that the information I have provided is complete and correct to the best of my knowledge.
Signature*
Date*
MM slash DD slash YYYY

RELEASE INFORMATION I, the above named person, being above the age of 18, in consideration of participating in an adventure travel trip (hiking, climbing, skiing, rafting, via ferrata, any activity considered as adventure or not), hereby acknowledge, agree, promise and covenant with Patterson Guide Service, Inc. d/b/a Mountain Spirits and all other persons or entities, on behalf of myself, my heirs, assigns, personal representatives and estate as follows:
ACKNOWLEDGEMENT OF RISK
I understand and acknowledge that the activity that I am voluntarily about to engage in bears certain risks which could result in injury, death, illness or disease, physical or mental. Among these risks are the following:
(1) The nature of the activity itself; adventure travel trip in Asia, South America, Europe and all countries world wide. This activity is potentially hazardous due to hazards, natural or man made, while traveling anywhere: travel to and from the trek (such as by taxi, bus or aircraft), accident or illness in remote places without medical facilities, illness due to food or water or dehydration, failure of equipment, forces of nature, including but not limited to, rock fall, avalanche, electrical storms, mountain storms, snow, rain and altitude sickness of whatever type, careless, reckless or malevolent behavior on the part of third parties and injury to property or injury or death due to political or socio-economic problems in the country of travel; (2) the acts or omissions or negligence in any degree of Patterson Guide Service, Inc. d/b/a Mountain Spirits, their agents, employees, and other persons or entities; (3) the acts of other participants in these activities; (4) my own physical condition or my own acts or omissions.
I understand and acknowledge that the above list is not complete or exhaustive, and that other risks, known or unknown, identified or unidentified may also result in injury, death, illness or disease.
I have read this section and initial it to show that I understand and agree:*
ACCEPTANCE OF RISK AND RESPONSIBILITY
Being aware that this activity entails risks of injury and damage to property, I agree and promise to accept and assume all responsibility and risk for injury, illness, death, disease and damage to property arising from my participation in these activities. My participation in these activities is purely voluntary, no one is forcing me to participate, and I elect to participate with full knowledge of the potential risks.
I have read this section and initial it to show that I understand and agree:*
RELEASE
I hereby voluntarily release and forever discharge Patterson Guide Service, Inc. d/b/a Mountain Spirits, their agents or employees and all other persons or entities from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in these activities, including specifically but not limited to negligent acts or omissions of Patterson Guide Service, Inc. d/b/a Mountain Spirits, their agents or employees, and all other persons or entities, for any and all injury, death, illness, disease or damage to my property.
I further agree, promise and covenant to hold harmless and indemnify, Patterson Guide Service, Inc. d/b/ a Mountain Spirits, their agents or employees, and all other persons or entities, for any such injury, death, illness, disease or damage to property.
I further agree, promise and covenant not to sue, assert or otherwise maintain any claim against Patterson Guide Service, Inc. d/b/a Mountain Spirits, their agents or employees, and all other persons or entities, for any injury, death, illness, disease or damage to property arising from or connected in any way with my participation in these activities.
I have read this section and initial it to show that I understand and agree:*
ACKNOWLEDGEMENT OF EFFECT OF THIS RELEASE AGREEMENT
I understand and acknowledge that by initialing and/or signing this document I have given up certain legal rights and/or possible claims, which I might otherwise assert and maintain against Patterson Guide Service, Inc. d/b/a Mountain Spirits, their agents or employees, and other persons or entities, including specifically, but not limited to, rights arising from claims for the acts or omissions or negligence in any degree of Patterson Guide Service, Inc. d/b/a Mountain Spirits, their agents or employees, and all other persons or entities.
It is further agreed and understood that if any Court should find any part of this document invalid, the remaining portion of this agreement shall remain in full force and effect.
It is further agreed, by and between the parties, that any legal dispute arising out of the Agreement will be adjudicated under the laws of the State of Idaho.
I have read this section and initial it to show that I understand and agree:*
I understand that this is the entire agreement between me and Patterson Guide Service, Inc. d/b/a Mountain Spirits, and that it cannot be modified or changed in any way by the representations or statements of any employee or agent of Patterson Guide Service, Inc. d/b/a Mountain Spirits or by me.
I have read this section and initial it to show that I understand and agree:*
My signature below indicates that I have read this entire document, understand it completely and agree to be bound by its terms:*
Today's Date*
MM slash DD slash YYYY
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Comments
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Welcome to Mountain Spirits Adventure Travel, owned and operated by husband/wife team, Pete Patterson and Kim Jacobs since 1996. Our trips are expressly designed to capture the true “Mountain Spirit” of any trek, mountain climb or heli-ski adventure.

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Mountain Spirits
P.O. Box 3689 Hailey, Idaho 83333 USA
208-720-5205

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Trip Registration and Release Form

Registration and Release Form

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Website By: Studio 360 Design