Name Of Trek:________________________________________ Date Of Trek:___________________________
Name Of Participant:___________________________________ Age:_________________________________
The Vishansar Adventure treks take place in some remote and less-developed regions, without means of rapid evacuation, or medical supplies and facilities. In the event of an accident, illness or injury an evacuation will be slow and uncertain as these trips take place in mountainous, high altitude, or other hazardous terrain. Common and uncommon signs and symptoms of altitude sickness should be expected. These include, but are not limited to: sleeplessness, coughing, loss of appetite, nausea, vomiting, and muscle cramps. Severe cases of altitude sickness can include pulmonary and/or cerebral oedema. In addition, exposure to microorganisms unknown to our digestive system may cause symptoms from a wide array of gastrointestinal disorders despite the best efforts to treat drinking water and prepare food properly. A poor state of health can greatly increase the dangers and risks that can be incurred on these trips. Therefore, The Vishansar Adventure requires that all climbers or trekkers are examined by a physician, are properly immunized for the destination(s).
Date:-_______________
Place:-_______________
The ____________________ Trek/Expedition route in the Himalayas has its share of risks and dangers, especially in respect to the terrain, weather, high altitude and desolate nature. Accidents on this trek can cause one to get injured, fall ill, and death too cannot be ruled out. I hereby declare that my participation in this trek is completely voluntary, and I am fully aware of the risks involved. I will not hold Trek the Himalayas wholly or partly responsible in case of any accident, illness, injury or death on the trek.
Date:-_______________
Place:-_______________
Signature______________
Contact details of person’s to be contacted in case of emergency.
Name:-____________________
Relationship:-_______________
Mobile No:-_________________
