Name: Mendoza Adventure Company and Mountain Guides
Address: Mendoza, Mendoza, AR

By submitting your personal information form to Andes Vertical Mountain Guides, you acknowledge and agree to all the terms and conditions outlined in the General Operation Conditions of the Reservation Form below.

If you’re attending with a friend or family member, please ensure that each participant completes a separate form. We appreciate your time and cooperation!

EXPEDITION
Starting date of the program*
DD slash MM slash YYYY
NAME*
(as in the passport)
First Name Last Name
EMAIL*
Insert your email Confirm email
Instagram
GENDER*
BORN DATE*
DD slash MM slash YYYY
NATIONALITY*
As in the passport
Passport number*
(Required for insurance)
PHONE NUMBER*
(include country code)

IN CASE OF EMERGENCY*
Contact name
EMERGENCY CONTACT'S TELEPHONE NUMBER*
(includE zip code)
EMERGENCY CONTACT'S E-MAIL*
ACCOMODATION INFORMATION*
Name or address
ARE YOU COVERED BY HOSPITALIZATION AND MEDICAL CARE INSURANCE?*
Contract full rescue insurance and full medical coverage with Global Rescue at the following link : https://partner.globalrescue.com/andesvertical/index.html
INSURANCE COMPANY
POLICY NUMBER
Would you like to include a box lunch for an extra U$D15? (only for full day treks)*
DO YOU NEED TO RENT GEAR?
PLEASE, DETAIL WHAT YOU NEED

QUESTIONNAIRE ON PHYSICAL CONDITION
IN ORDER TO ENABLE US TO PROVIDE YOU OUR BEST SERVICE, IT IS VERY IMPORTANT THAT YOU ANSWER THE FOLLOWING QUESTIONS. IT IS ESSENTIAL THAT ALL THE INFORMATION YOU OFFER US IS TRUE AND UPDATED.
HOW TALL ARE YOU?*
WHAT IS YOUR WEIGHT?*
WHAT IS YOUR NORMAL BLOOD PRESSURE?*
(MIN. AND MAX. VALUES)
ARE YOU UNDERGOING ANY MEDICAL, PSYCHOLOGICAL OR PSYCHIATRIC TREATMENT?*
PLEASE, SPECIFY
DO YOU TAKE ANY MEDICINE ON A REGULAR BASIS?*
PLEASE, SPECIFY
ARE YOU ALLERGIC?*
PLEASE, SPECIFY
HAVE YOU EVER SUFFERED FROM ANY OF THE FOLLOWING CONDITIONS: ASTHMA, DIABETES, HEART DISEASE, EPILEPSY?*
PLEASE, SPECIFY
HAVE YOU EVER SUFFERED FROM ANY OTHER CONDITION WE SHOULD BE INFORMED ABOUT?*
PLEASE, SPECIFY
DO YOU HAVE KNEE PROBLEMS, BACK OR CHEST?*
SPECIFY
DO YOU HAVE ANY RESTRICTED DIET?*
PLEASE, SPECIFY
DO YOU SMOKE? HOW MANY CIGARETTES AND HOW OFTEN?*
DO YOU HAVE ANY REGULAR FITNESS PROGRAM? WHAT KIND OF ACTIVITY?*
ARE YOU PREGNANT?
PLEASE, WRITE A SUMMARY OF YOUR OUTDOOR EXPERIENCE*
GENERAL CONDITIONS*
- I ACCEPT THE OPERATION GENERAL CONDITIONS

Personal form

QUESTIONNAIRE ON PHYSICAL CONDITION