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Medical History Form

Volunteers must be in good physical condition to participate in WTA work parties that require a medical history form. These work parties may require physically and mentally demanding exertion, including extended hiking or backpacking, for multiple days in a row. These work parties may be in remote locations without easy access to medical facilities or means of contacting rescue and medical personnel.

WTA is requesting this information in the interest of the safety of both you and other crew members. The answers you provide will help your crew leader and WTA staff be better prepared to respond in an emergency. Your answers are not generally used to screen you for a trip but we may contact you to discuss your capacity to successfully complete the work parties for which you have registered. This form is valid for work parties during this calendar year. Information on this form is confidential.

Emergency Contact Information
In an emergency, contact:
If they can't be reached contact:
Medical Insurance Information
Vitals
Fitness
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Allergies
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Vision
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Medical History
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Physical Examination