REQUIRED MEDICAL INFORMATION. Traveler must provide any medical information reasonably requested by Infinity or FA. Traveler hereby agrees to provide such medical information via the medical information questionnaire (“Medical Questionnaire”) on page three (3) of Infinity’s or FA’s Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement & Medical Questionnaire, as further discussed in Section 16 and available on Infinity’s website at xxx.xxxxxxxxxxxxxxxxxxx.xxx or FA's website at xxxxx://xxx.xxxxxxxxxxxxxxxxxxxx.xxx/en/. Traveler agrees to complete the Medical Questionnaire truthfully and to disclose all relevant medical information fully and accurately. Infinity or FA will maintain the information in strict confidence and shall not disseminate such information unless required to do by law or as needed in the event of a medical emergency. Infinity or FA reserves the right to request further information or professional medical opinions where necessary, as determined in its sole discretion, for Traveler’s safety or the safe operation of a Tour. Infinity or FA reserves the right to deny Traveler permission to travel or participate in any aspect of a Tour at any time and at Traveler’s own risk and expense where Infinity or FA determines, in its sole discretion, that Traveler’s physical or mental condition renders Traveler unfit for travel or Traveler represents a danger to Traveler’s self or others. Infinity or FA may refuse to include in a Tour anyone with certain medical conditions if reasonable accommodation or alternatives cannot be arranged. Infinity or FA may refuse to include women who are over 24 weeks pregnant in a Tour for the safety of the traveler’s self, the unborn child, or others. It is Traveler’s responsibility to assess the risks and requirements of each aspect of the Tour based on Traveler’s own unique circumstances, limitations, fitness level, and medical requirements to determine if he or she is fit for a particular Tour. Infinity or FA recommends that Traveler consult his or her physician to confirm Traveler’s fitness for travel and participation in any planned activities. Traveler should seek his/her physician’s advice on vaccinations and medical precautions. Infinity or FA does not provide medical advice. Travel with Infinity or FA may involve visiting remote or developing regions, where medical care may not be easily accessible and medical facilities may not meet the standards of those found in Traveler’s home country or home locality. The condit...
REQUIRED MEDICAL INFORMATION. (California Only)
REQUIRED MEDICAL INFORMATION. 11.1 The Participant shall be required to provide any medical information reasonably requested by the Corporation. The Corporation shall provide each Participant with a standard template medical form that each Participant shall be required to complete and return to the Corporation by no later than 30 days prior to the commencement of the Event.
REQUIRED MEDICAL INFORMATION. Please describe any health conditions requiring medication (list them & indicate refrigeration), treatment, special restrictions, or consideration: Do any medications require refrigeration? No Food Restrictions/Allergies: Yes Date of Last Tetanus Shot: Unknown Minors may only participate in the Event with consent from their parent or guardian. I, the undersigned parent or legal guardian of the individual(s) below, consent to the named person’s participation in the Event and Riskier Activities and agree to the terms of this Agreement. I take responsibility for the participant and his/her knowledge of all safety rules. Name of Minor Date of Birth Name of Minor Date of Birth 1: 4: 2: 5: 3: 6: Adult Name: Signature: (Electronic Signature – name followed by zip or last four digits of Date: SSN) Adult Name: Signature: (Electronic Signature – name followed by zip or last four digits of Date: SSN) Address: Phone: Email: Emergency Contact: Phone:
