CLIENT BRIEFING FORM

Once you have made a booking with us, please complete this form and submit to us.
If travelling in a group, each person must complete this form.

Client Name *
Client Name
If travelling in a group, each person must complete this form separately
Gender *
Please provide phone number where you can be contacted at most times, eg. mobile phone
Please provide name and contact details of a person we can contact in the event of an emergency. Please state their relationship to you, ie. spouse, parent, etc.
Please provide the address and phone number of your accommodation in Taranaki.
Health Check List *
Please check boxes below if you are affected by any of the following health conditions
Please provide any information regarding your health status and provide details of any conditions checked in the above list. If you have no health issues, please write that.
Are you taking any Medication? *
If "Yes" please provide the name of the Medication and frequency of doses
Is there anything else we should know in order to help keep you safe, eg. fear of heights, non-swimmer. Please provide any additional information you feel is relevant to this trip.
Risk Disclosure Acknowledgement *
I accept the activity I am about to undertake is a potentially hazardous activity. Some of the hazards that you may encounter are; uneven track surface, cold temperatures, bright sunlight (snow blindness), rock fall, equipment failure, fatigue, and dehydration. The Guide will take all reasonable steps to minimise the hazards, but I acknowledge they can not be totally eliminated. I understand the hazards involved and in no way hold the Guide responsible for any harm that may occur to me while undertaking this activity. I have disclosed to the Guide any physical or mental impairment, allergy, pre-medical conditions or sickness that may effect me or my Guide during the activity or subsequent to any personal injury.

Note: An audited Safety Plan containing a list of hazards, and safe operating and emergency procedures, is available on request.

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