Girl Trekker Form & One Day

Girl Trekker Form
Personal Details
Full Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Date of Birth *

- Day - Month Year
Please Note:

Girl Trekkers over 70 require a medical certificate from their doctor
Emergency Contact *

First Name Last Name
Phone Number *
Photographs

Do you give permission for photographs to be taken of you by the guides? These images may be uploaded to a GirlsTrek private group sharing website and drawn upon for publication on our Facebook, Instagram, LinkedIn, YouTube feed or website.
Permission to use my images *

Yes No
Fitness and Health Details
Dietary requirement *
Please choose
Specific details of dietary requirements
Height *
Weight *
Smoker *

Yes No
Please provide a detailed response of your current weekly exercise activity including time spent on each activity
Currently Weekly Activity *
Medical conditions that require a medical certificate from your doctor

Do you currently have, or have you ever experienced any of the following conditions:
Medical Conditions 1 *

Palpitations / chest pain Blood Disorder Heart Condition Stroke Diabetes Dizziness or Fainting Liver or Kidney conditions Epilepsy Cancer (Recent) Other None of the above
Details of condition/s
Medical conditions that DO NOT require a medical certificate from your doctor
Medical Conditions 2 *

Low or High Blood Pressure Gout Hernia Stomach / Duodenal Ulcer Asthma or Breathing condition Raised Cholesterol Other None of the above
Details of condition/s
Are you pregnant ? *

Yes No
Are you receiving treatment from a Physiotherapist or other health professional? *

Yes No
Have you had surgery in the past 12 months? *

Yes No
If yes, please provide details
Sport and Physical Injuries
Do you have, or have you had any of the following;
Injuries *

Tendon / ligament damage Surgery due to injury Broken or Fractured bones Back or Neck Pain Joint Pain Muscular Pain Dislocation Arthritis Other None of the above
Details of Injury
Full Disclosure

Do you have any other medical or physical problems or issues we should know about before commencing an exercise program and/ or undertaking your trek?
If yes provide details
How did you hear about GirlsTrek? *

Friend Facebook Instagram HikeFit
How did you hear about HikeFit? *

Friend Facebook Instagram GirlsTrek
Terms and Conditions *
Should be Empty:

Girl Trekker Form

Fitness and Health Details

Sport and Physical Injuries