Self Assessment VIC

Name

Phone

Street Address

Email Address

Other participants name & phone no. (if booking for more than 1)

Course or tour date

Rate your fitness level between 1 and 10, 10 being most active

What sports or fitness activities do you do regularly and how often?

Do you have a medical condition or take any prescription medications which may affect you during vigorous exercise? If yes, please detail:

Do you suffer from asthma? If yes, please provide us with your Asthma Management Plan

Are you a skier, telemarker or snowboarder?

Approx how many days on average have you spent skiing/riding in each of the last 3 years (prior to this season)

Are you confident making continuous linked turns in untracked snow? If not, please describe your skiing/riding ability

How comfortable do you feel on steeper slopes (black runs) (1-10 with 10 being very confident)

Have you been in the snow backcountry either in Australia or overseas before? If yes, please give a brief description:

What backcountry touring equipment and/or avalanche safety equipment do you own (if any)?

I have read and agree to the terms of the Alpine Access risk waiver.Yes/no

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