HAPPY HIKERS EMERGENCY INFORMATION
Please complete and keep in your pack on ALL hikes.
NAME:__________________________________________ PHONE: HOME____________
ADDRESS:_______________________________________
WORK____________
_________________________________________________ BIRTH DATE:____________
EMPLOYER:______________________________________
INSURANCE COMPANY:___________________________ POLICY #:______________
EMERGENCY CONTACTS:
NAME:______________________________RELATIONSHIP:_____________
PHONE:__________
NAME:______________________________RELATIONSHIP:_____________
PHONE:__________
Please list any allergies (medicines, insect bites, etc.):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Please list medications you are taking:_____________________________________________________
_________________________________________________________________________________
Do you wear contact lenses?______________ Blood Type:_________________
Any other information that might help you survive a wilderness injury?
__________________________________________________________________________________
__________________________________________________________________________________
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