PARTICIPANT MEDICAL INFORMATION FORM
We ask for this information so that our staff will know in advance of special medical conditions you may have, rather than
learning about them in a crisis. Also, in the event of serious injury or illness, this form provides emergency medical personnel
with a useful medical history. After reviewing this form, a RNR guide may contact you to discuss whether the trip will be
safe and enjoyable for you considering your medical history.
We will keep the information on this form confidential. It will be seen only by staff, medical personnel, or others who
know and understand its confidential nature. The form will be retained along with your liability waiver for at least one
year following the trip, after which it will be destroyed. If you choose not to go on the trip, this form may be destroyed immediately.
"Yes" answers to any of the questions on this Form do not automatically exclude a participant from a RNR activity.
However, the RNR, at its sole discretion, may not allow in dividuals to participate in any activities that could have a reasonable
likelihood of causing harm to the participant or others due to a medical, physical or psychological condition.
Failure to report current and pertinent medical information could result in injury or illness or compound an existing injury or
illness to any participants involved in a RNR activity.