Participant questionnaire

Participant Questionnaire for multiday, self-sufficient trainings and expeditions

Some of our courses as well as our tours and expeditions take place in remote areas where rescue services cannot necessarily arrive within the usual times. In some places we have no mobile phone coverage and are reliant on satellite emergency call systems.

It is therefore important to be aware of any special medical conditions our participants may have.Every tour is accompanied by at least one guide trained in emergency medical care on tour (Wilderness First Aid), who will also act in an emergency. And even if there is no emergency, it helps us to know your particular circumstances so that we can adapt to you in the best possible way.

We therefore ask you to fill in this questionnaire truthfully; it must not be more than 6 months old at the time of the start of the relevant trip.

If you have any questions, please speak to your doctor.

Participant

First name *

Last name *

Customer number, if at hand

Providing your customer number helps us to process your data, but is not necessary.

eMail address *

We always require a valid e-mail address directly from you at this point. It is used for automatic confirmation of the data transmitted here.

Emergency contact

Full name of emergency contact *

Relationship (partner/friend/mother/father/colleague/etc.) *

Street address with house number/apartment/etc. *

Zip code *

City *

Country *

Phone number *

+1

This should be a mobile number

Size information of participant (only when using rental equipment)

Size specifications for equipment rental? *

I will not rent any equipment and therefore do not provide any size information

Body height in cm *

Shoe size *

Please specify which size measure you are giving (EU/US/UK/cm)

Clothing size (S-XXL) *

Special medical features

Are allergic reactions known? (e.g. hay fever, insect bites, food allergies) *

Please provide details *

Do you suffer from a respiratory disease? (e.g. asthma, chronic bronchitis) *

Please provide details *

If heart or circulatory problems are known (e.g. arterial hypotension) *

Please provide details *

Do you suffer from Lyme disease or TBE? *

Please provide details *

Do you suffer from haemophilia/bleeding disorder? *

Please provide details *

Do you suffer from phobias/are you aware of any particular fear situations (e.g. fear of heights, fear of the dark, fear of water)? *

Please provide details *

Are you currently and acutely suffering from a mental illness (e.g. depression, psychosis)? *

Please provide details *

Do you suffer from epilepsy? *

Please provide details *

Have you had a major operation in the last six months/have you had bone fractures? *

Please provide details *

Do I have to take special medication regularly? *

Please provide details *

Physical/motor skill prerequisites

If you are unsure, please speak to your doctor.

Are you able to carry normal to heavy loads on your back for several hours (12kg-20kg, depending on your personal equipment)? *

Please provide details *

Are you a safe swimmer? *

Please provide details *

In your opinion, what other medical or motor specialities are important for us to know? (If none, please enter "none") *

With your entry or the entry "none" you confirm that you have named all relevant special features or that to the best of your knowledge you have none.

Final information and transmission

Optional: Selected prior experiences

If not already known, we would be pleased to hear about your previous experience in outdoor activities on the water (canoe/kayak/packraft/boat in general) and on land. Thank you very much!

Optional: Dietary preferences

Do you have any special dietary preferences that you would like us to know about? (For example lactose intolerance, gluten intolerance, no alcohol, etc.)

Declarations *

I confirm that all information provided is true and correct to the best of my knowledge

I undertake to inform Land Water Adventures of any changes before the start of the tour

I confirm that I am covered by health insurance for the type, period and country of implementation of the activity (some international health insurance policies in particular exclude so-called high-risk sports. Whether the booked activity is included depends on the provider and policy and must be specifically requested from the respective insurance company)

I declare to comply with the LWA Nature Conservation Guidelines during the undertaking.

Data protection and transmission of data

This questionnaire is sent directly to our server via an encrypted connection.

Before submitting the form, please check the address bar of your browser to ensure that there is an authenticated, secure connection to the domain land-water-adventures.com via the Land Water Adventures SSL certificate.

The personal data provided in this questionnaire will be treated confidentially upon arrival on our server and processed in accordance with our privacy policy with special protection of personal data.