APPLICATION FORM

Please note: You can only book online if you provide the secure server with a valid credit card number.

If you wish to pay by cheque please complete, print and sign the application form,  and post it with cheque to:
Alpine Recreation, P.O.Box 75, Lake Tekapo, New Zealand.

Any information you provide will be treated as strictly confidential

Please enrol me for:   Date:

Please specify if necessary

PERSONAL

Given name:
Family name:
Street / Post Box:
City:     Post Code:
Country:
Phone (home): Phone (work):
Fax:                   E-mail:            
Date of birth: Occupation:

EMERGENCY CONTACT
Name: Relationship:
Phone: Address:
 

MEDICAL
Please provide the following information about your health and fitness which may affect the adventure you are going to undertake. Circle the appropriate answer and answer all questions.		 Tick "Yes" or "No"
A) Do you/have you suffered from: a heart condition?
high blood pressure?
epilepsy?
a bronchial disorder?
asthma?
diabetes?
B) In the last five years, have you: suffered any severe injury?
undergone any surgical operation?
C) Do you have any known allergies?
D) Are you taking any medication?
E) Do you suffer from any other medical condition(s) which might affect your ability to participate in a Ball Pass Crossing? Eg. Any recurring sports injury?

If you have answered "Yes" to any part of A) to E) above, would you please elaborate?

DIETARY REQUIREMENTS
Please indicate if you are vegetarian or have any other dietary requirements.

EXPERIENCE & FITNESS Tick "Yes" or "No"
1) Do you have previous tramping/hiking/backpacking/bushwalking experience?  
If so, how many years? 
2) Can you walk 6-8 hours in a day without difficulty?
3) Are you able to climb up and down steep slopes with no fear of heights?
4) Can you clamber up and around big rocks where you may need to use both hands
5) Do you have good balance and are you well-coordinated?
6) How do you rate your fitness?
7) Are you of at least average fitness?
Additional Information Introductory Climbing
Do you have any rock climbing experience?
If so, up to what grade?
Additional Information FitzGerald Pass Crossing
Do you have previous cramponing experience?
Additional Information Intermediate and Advanced Climbing
Please give full details of your previous climbing experience and current fitness training. For Mount Cook and Mount Tasman please give a list of previous ascents.
Additional Information Ski Touring
My standard of    SKIING IS: 
 

CANCELLATION
I accept the booking conditions and acknowledge that Alpine Recreation cannot refund any trip fees if a trip has to be cancelled after commencement due to unforeseen and uncontrollable circumstances (inclement weather, bad road conditions etc.). If I choose to cancel a trip, I will pay the appropriate cancellation fee as set out in the Company's Booking Conditions

 

EQUIPMENT
I agree that if I damage the Company's equipment beyond normal wear and tear or lose their gear on a trip, I will be liable for replacement or repair costs as the directors of the Company decide.

 

 

PAYMENT
In order to secure a booking a 50% deposit of the tour price is required. The balance is due four weeks before departure date.

I am sending a cheque for the amount of
      I will send a cheque for the balance four weeks before departure
Please charge my credit card for the amount of
Please charge my credit card for the balance four weeks before departure

   

Please contact us by phone or fax if you do not receive confirmation within 3 days of booking