NOTE: Canmore Cave Tours does not accept paper waivers, please submit electronically.

CANMORE CAVERNS LTD. #202 - 129 Bow Meadows Crescent, Canmore AB T1W 2W8

Medical Questionnaire

Why do we need to know this stuff?

Having an understanding of any pre-existing conditions or limitations can help us pre-plan any alterations or considerations we need to make. Providing us with this information is integral to providing the best experience we can, and the best possible care in the event of an emergency.

Personal Information

Full Name

Street Address and Town

Province/State

Postal Code/Zip Code

Country

Phone Number

What trip are you taking

Emergency Contact

Emergency Contact Name

Emergency Contact Number

Relationship to Emergency Contact

Medical History

Describe any existing medical conditions

Have you been under the care of a physician in the last 12 months? If Yes, Why?

Optional

Any recent surgery that you are recoverying from (mobility limitations, etc.)?

Optional

Date of last Tetnus Shot

Optional

Medications

Please list any medications (prescription or otherwise) that you are currently taking:

Optional

Medication considerations: Ensure your medications are not expired. Ensure you can store it in a waterproof, shockproof container, with proper labeling. For life sustaining medications, bring a duplicate set for your guide to carry.

Allergies

Do you have any known allergies

Optional

What is a typical reaction for you ?

Optional

What is the treatment, if any, for your allergic reactions?

Optional

Physical Limitations

Do you have any conditions that limit your mobility or ability to do physical activities?

Optional

Other Limitations

List any other factors that may impact your experience (claustrophobia, fear of the dark or heights, etc.)?

Optional

Date of Signature

Click to Sign

Signature

NOTE: Canmore Cave Tours does not accept paper waivers, please submit electronically.

2. Medical Questionnaire