Prepaid Program Application

This Application form is for those participants who have already paid their deposit and registered for one of our programs.
This is a simplified form with no financial information included.

If you have not yet registered and placed a deposit for your desired program, you can do so with our standard online application.

You must be at least 18 years of age to use this online application. For those participants under age 18, contact our office.

Note: A number of our trips have specific cancellation/refund policies, including but not limited to: Denali, Everest, Vinson, Cho-Oyu, Greenland, Carstensz Pyramid, The Matterhorn, Mont Blanc.

If you have any difficulty using this form please email Climb@AlpineAscents.com with your name and the program you are registered for.

We look forward to climbing with you!


Today's Date


Which Program Are You Already Registered For? Program Calendar


MOUNT RAINIER PROGRAMS

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WORLDWIDE CLIMBS

TREKS & TOURS

 

































 


Departure Date For Program You Are Registered For
(DD/MM/YYYY)

I would like to use the Auto-Pay feature and have my balance automatically charged on the due date.
Yes No

 

Notes for our Program Staff regarding your reservation go here:
 

Mailing Address  
First Name
Missing First Name
Last Name
Missing Last Name
Preferred Name
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email confirm A value is required.The values don't match.
Mailing Address
Missing Address
Address Continued
City Missing City
State (US/Canada)
State (Outside US/Canada)
Zip/Postal Code Missing ZIP
Country
Home Phone Missing Phone
Work Phone
Cell Phone
Occupation
Date of Birth mm/dd/yy
Sex Male Female
Height
Weight
T-Shirt Size
How did you learn about Alpine Ascents
Have you participated in other Alpine Ascents trips/courses?
If Yes, please list:

In Case Of Emergency Please Notify
Name
Relationship
Address
Phone



INTERNATIONAL PROGRAMS ONLY (optional)
Passport # Date of Expiration
Date of Issue Place of Issue
Place of Birth Citizenship

Member Name

 



MEDICAL INFORMATION
Please answer each question in earnest using the fields below. You may also send a separate email to climb@alpineascents.com. Your signature/check mark on this form certifies that your statements are true. Alpine Ascents International reserves the right to refuse service at the your expense due to misrepresentation of biographical information. Please note that medical informationwill be shared with your guides to assist with any health related issues while on your course or expedition. Signing this form indicates you comply and understand the physical requirements for this program.


Have you been hospitalized in the past two years? If yes, please describe.
No Yes. Please Describe:

Have you ever had frostbite or any related cold weather injury/illness?
No Yes. Please Describe:

Have you ever experienced any form of altitude illness? If so, please describe rate-of-ascent, altitude, medication and recovery procedures.
No Yes. Please Describe:




Do you wear corrective lenses?
No Yes

 

Do you currently smoke or have you been a past smoker. Please explain
No Yes

Do you have any pre-existing conditions not mentioned above. If so, please describe
No Yes

Are you familiar with standard first-aid and current CPR techniques?
No Yes

Please check and describe below if any history of:


 


FITNESS/CLIMBING HISTORY

You may email additional information to climb@alpineascents.com

Please describe what you do to keep fit and any/all mountaineering and other outdoor experience you may have. This information is very
useful, as we strive to cater each trip to match individual needs and goals. Signing this form indicates that you understand and comply with the physical fitness requirements for your program.

Please describe your weekly workout routine:

Please describe your planned workout in preparation for this upcoming course or expedition:

Please note the highest altitude you have reached

Please note the heaviest weight you have carried and list location and how many days you have carried that weight.

Please list all mountaineering courses you have completed, if any.
Include a brief description of topics covered

Please list all mountaineering and related outdoor activities completed.
 

By Checking this box I am signifying that the above medical information is correct. Check

 


TERMS AND CONDITIONS

CANCELLATION AND REFUND POLICY: Note: Alpine Ascents International highly recommends trip cancellation insurance for all expeditions. Due to the nature and heavy costs of government and operator permits, Alpine Ascents International must adhere to a stringent refund policy.
Each deposit, regardless of amount, includes a $200.00 non-refundable registration fee.
Full refunds, less registration fee, will be provided 120-days prior to course, trek and/or expedition date.
50% refunds will be provided 90-120 days prior to course, trek and/or expedition date.
No refunds will be provided 89 days prior to course, trek and/or expedition date.
All refund requests must be made in writing and be received in our office within the 90-120 day period, as stated above.
All balances are due 120 days prior to departure date unless otherwise specified.
Participants whose balances are not received by the 120-day deadline as stated above, risk forfeiture of their place on the expedition.
Note: Alpine Ascents reserves the right to waive any fees. As we offer personalized service, we will attempt to accommodate changes and cancellations when necessary, waiving certain fees when feasible.

TRIP CANCELLATION INSURANCE:
We highly recommend purchasing trip cancellation insurance. Alpine Ascents International offers plans in conjunction with Travelex. Detailed policy information
will be sent upon receipt of deposit. Policies available online at www.Travelex-Insurance.com. Enter location #47-0553.

PARTICIPANT RESPONSIBILITY:
Trip participants are responsible for their own well-being. This includes good health and strong physical condition. Participants joining a trek, course or
mountaineering expedition may be required to obtain a physician's release prior to departure. Expedition members are responsible for: knowing all pre-departure
information, preparing proper equipment and clothing, conforming to basic standards of personal hygiene (to minimize the risk of travelers diseases) and acting in
a considerate manner toward all group members and with respect for each country's customs. Participant also agrees to follow the appropriate Leave No Trace
practices. Participants are prohibited from using illegal drugs and alcohol while on AAI courses and climbs. Participant gives their consent for AAI to use their
photograph, likeness and/or voice to be used in its publications, including its website.

AIRLINE RESPONSIBILITY:
The air carrier will not be held responsible for any act, omission or event while the passenger is not on-board the designated aircraft or terminal conveyance.
Passenger/Airline contracts stand in effect while the passenger is on-board each particular aircraft. This applies to all carriers.

CONDITIONS OF CLIMBING EXPEDITIONS, COURSES AND TREKS:
We are committed to helping climbers achieve their personal goals safely and enjoyably.
Alpine Ascents International, Inc., its owners, sponsors, agents, employees, officers, directors, associates, affiliated companies and subcontractors (herein after collectively
referred to as "AAI"), hereby give notice that they act only as agents for hotels, transportation companies, land operators and suppliers of travel services.
AAI assumes no responsibility or liability in connection with the operation or service of any aircraft, motor vehicle, other conveyance, inn, lodge or hotel which
may be used wholly, or in part, for services to Alpine Ascents International, Inc. and its clients. AAI, its operators, airlines and agents will not be responsible for
any act, error, omission, nor for any injury, loss accident, delay, inconvenience, irregularity or damage which may be occasioned by any cause whatsoever. This
includes acts of nature, civil disturbance, government restrictions or failure of any means of conveyance to adhere to published schedule.

AAI reserves the right to change the price of, cancel or withdraw any trek, course or expedition for any reason whatsoever prior to departure. After departure,
AAI reserves the right to alter or omit any part of the itinerary, to substitute hotels or leaders, to change any means of conveyance without notice and without
allowance of refund, with liability for increased costs (if any) borne by the trek, course or expedition members. AAI reserves the right to accept or reject any
person as a trek, course or expedition member at any time.

I understand, and am aware, that during the trek, climb, course or expedition in which I am currently participating, or will participate in, under the arrangements
of AAI, certain risks and dangers may arise including, but not limited to: altitude; steep or treacherous terrain; inclement weather; avalanches, rock fall and other
natural occurrences; misuse, failure or loss of equipment; shortage of food or water supply; the hazards of traveling in politically unstable areas; the dangers of civil
disturbances and war; the forces of nature; acts or omissions of AAI; travel by boat, automobile, train, ship, aircraft or other means of conveyance; and accident or
illness in remote places without access to medical facilities, transportation, or means of rapid evacuation and assistance.

I certify that I am familiar with the dangers, hazards and risks incident to trekking and mountain climbing expeditions/courses as listed above. And I accept and
clearly understand that these hazards and risks may result in personal injuries to myself and others, including paralysis and death, and hereby expressly assume all
of the above risks including, the risks of acts or omissions of AAI, and do hereby expressly agree to hold AAI harmless and defend them against any and all liability.

In consideration of the services furnished me, and to be furnished me as a member of this trek, course and/or mountaineering expedition, I hereby release AAI
and all the members of the trek, course and/or mountaineering expedition from any and all damages, injuries, losses, or any cause of action which may result in
me, my legal representatives or others purporting to exercise statutory or other rights arising out of, or in connection with this expedition. And I hereby assume
each and every damage incident to my participation, and agree to indemnify and hold harmless AAI and all members of the trek, course and/or expedition against
any sums which they, or any of them may be subject to pay in consequence of any claim or demand by or through me, or resulting from my being a member of
this trek, course and/or mountaineering expedition.

Check By Checking this box, I certify that I agree to all TERMS & CONDITIONS as stated above.
Name Missing Name Date A value is required.Invalid format.

PARTICIPANT AGREEMENT, RELEASE, AND ASSUMPTION OF RISK

In consideration of the services of Alpine Ascents International, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "AAI"), I hereby agree to release, indemnify, and discharge AAI, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that rock climbing, mountaineering, and trekking in foreign countries entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

The risks include, among other things: loss or damage to equipment being used; being lost or separated from their guides or companions; the hazards of walking on uneven terrain and slips and falls; being struck by rock fall, icefall or other objects dislodged or thrown from above; the use of climbing ropes and equipment; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; the forces of nature, including lightning, weather changes and avalanche; weather and altitude can be extreme and can change rapidly without warning; the risks of falling off the rock or mountain; the risk of altitude and cold including hypothermia, frostbite, acute mountain sickness, cerebral and pulmonary edema; and exposure to potentially dangerous wild animals, insect bites, and hazardous plant life; travel in remote areas with poor or no access to emergency and/or medical services; my own physical condition, and the physical exertion associated with this activity.

Foreign countries have their own laws and standards of acceptable conduct; food and water related illnesses; foreign political, legal, social, transportation, health, and economic conditions; different standards of design, safety, and maintenance of buildings, public places, and conveyances; local & medical facilities and providers; weather conditions; criminal activity, environmental hazards; standards of living and health standards that are not equivalent to life in the United States.

Furthermore, AAI employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather, other environmental conditions. They might misjudge whether the terrain is safe for travel or where or when an avalanche may occur. They may give incomplete warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless AAI from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of AAI's equipment or facilities, including any such claims which allege negligent acts or omissions of AAI.
4. Should AAI or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
6. In the event that I file a lawsuit against AAI, I agree to do so solely in the state of Washington, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against AAI on the basis of any claim from which I have released them herein.

Check I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Name Missing Name Date A value is required.Invalid format.


The following form is also required for all Denali, Alaska, Cascades, Washington and Rainier Programs.
Please skip the release form below if you are going on an international (Outside of the US) program.

National Park Release Form

VISITOR’S ACKNOWLEDGEMENT OF RISKS

In consideration of the services of Alpine Ascents International their officers, agents, employees, and stockholders, and all other persons
or entities associated with those businesses (hereinafter collectively referred to as “AAI”) I agree as follows:

Although AAI has taken reasonable steps to provide me with appropriate equipment and skilled guides so I can enjoy an activity for which I
may not be skilled, AAI has informed me this activity is not without risk. Certain risks are inherent in each activity and cannot be eliminated
without destroying the unique character of the activity. These inherent risks are some of the same elements that contribute to the unique
character of this activity and can be the cause of loss or damage to my equipment, or accidental injury, illness, or in extreme cases,
permanent trauma or death. AAI does not want to frighten me or reduce my enthusiasm for this activity, but believes it is important for me to
know in advance what to expect and to be informed of the inherent risks. The following describes some, but not all, of those risks:

The following describes some, but not all, of those risks: the hazards of walking on uneven terrain and slips and falls; being struck by rockfall,
icefall or other objects dislodged or thrown from above; the use of climbing ropes and equipment; the forces of nature, including lightning,
weather changes and avalanche; the risks of falling off the rock, mountain or into a crevasse; the risks of exposure to insect bites; the risk of
altitude and cold including hypothermia, frostbite, acute mountain sickness, cerebral and pulmonary edema; my own physical condition, and
the physical exertion associated with this activity.

I am aware that mountaineering, hiking, climbing, and camping entails risks of injury or death to any participant. I understand the description
of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. I agree to assume
and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this
activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks.

I acknowledge that engaging in this activity may require a degree of skill and knowledge different than other activities and that I have
responsibilities as a participant. I acknowledge that the staff of AAI has been available to more fully explain to me the nature and physical
demands of this activity and the inherent risks, hazards, and dangers associated with this activity.

I certify that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor
children in my care, custody, and control, for bodily injury, death or loss of personal property and expenses as a result of those inherent risks
and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of my negligence in participating
in this activity.

I have carefully read, clearly understood and accepted the terms and conditions stated herein and acknowledge that this agreement shall be
effective and binding upon myself, my heirs, assigns, personal representative and estate and for all members of my family, including
minor children.

National Park Release

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Name Date

 


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Note: If this form does not submit properly, please review your form and ensure there are no missing required fields.


Please be advised that Alpine Ascents International does not lend, sell or share personal information, or addresses with any organizations. We respect your right to privacy.

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