Health Declaration & Waiver Official Kawasan Quest Canyoneering Waiver & Health Declaration. Sign online for a faster check-in at Kawasan Falls. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Date of BirthHeightWeightGenderPermanent AddressBlood PressureEmergency Contact NameEmergency Contact NumberCANYONEERING TRIP INFORMATIONBadian Canyoneering trip is at most a 3-hours eco-adventure in a remote setting where evacuation to modern hospital facilities is not immediately possible. You must expect extreme weather conditions ranging from low temperature to extreme heat and humidity. Sudden environmental changes are to be expected and anticipated. You may come along uneven, slippery, and steep terrain. You might also be swimming against strong water current and experience long tough trail. Be sure that you are to be responsible for yourself and follow all rules and regulations your tour guide presents to you. If you have questions about the activity, you may ask your tour guide(s).GENERAL MEDICAL HISTORYInstruction to participants: Please check YES or NO for each question. Each must be answered, but keep in mind that a "YES" answer do not necessarily mean you will not be able to do your canyoneering activity. Providing your answers can make it easier for your tour guides to assist you in any circumstances. For MALE guests, kindly skip Q.9 & 12.1. Respiratory problems?YesNo2. Gastrointestinal Disturbances?YesNo3. Diabetes or Hypoglycemia?YesNo4. Hypertension?YesNo5. Bleeding or blood disorder?YesNo6. Hepatitis or other liver diseases?YesNo7. Neurological issue? Epilepsy? Seizures?YesNo8. Dizziness or fainting episodes?YesNo9. Treatment or medication for menstrual cramps?YesNo10. Disorder of the urinary or reproductive tract?YesNo11. Do you see a Medical/Physical specialist of any kind?YesNo12. Are you pregnant?YesNo13. Treatment or counseling with a mental health professional?YesNo14. Cardiac Problems?YesNo15. Heatstroke/Heat Exhaustion or any other related illness?YesNo16. Physical or Sensory Limitation?YesNo17. Any other health complaint not listed above?YesNoIf you have filled “YES” on any of the questions from No. 1 – 17, please provide a brief description of your condition and any associated physical limitations.18. Knee, hip, ankle, shoulder, arm, back, or other injuries to muscle, tendons, ligaments, or bones (including sprains) and/or operations?YesNoKnee, hip, ankle, shoulder, arm, back, or other injuries to muscle, tendons, ligaments, or bones (including sprains) and/or operations? YesNoIf so, please specify:19. Any allergies? Especially to insect bite or bee stings?YesNo20. Are you allergic to any medications? YesNoIf YES, please list them along with their severity:21. Are you currently taking any medications which limits physical activity?YesNoIf YES, please list them together with their restrictions/side effects: (copy)22. Do you have a history of Acute Mountain Sickness?YesNo23. Do you have any Physical, Medical, or psychological conditions not listed above?YesNo24. Year las TETANUS IMMUNIZATION: If you can’t remember, was it within the past five years?YesNo25. Swimming ability (choose one)Non-SwimmerRecreationalCompetitive26. Have you participated in any scuba diving or freediving activity within the last 24 hours?YesNo27. Do you exercise regularly?YesNoIf YES, rate the intensity level (choose one)EasyModerateCompetitive28. Do you SMOKE?YesNo29. Have you had enough sleep (at least 6–8 hours) in the past 24 hours?YesNo30. Did you eat a proper meal before joining the canyoneering activity?YesNo31. Do you have any dietary restrictions or food allergies?YesNoIf YES, please describe: Are you a vegetarian, vegan, gluten-free, or lactose intolerant? How strict are you? And if you have food allergies, what happens likely when you are exposed to allergens?32. If you have strict food restrictions, please list some of the meals that you (might) particularly allow: (including for HISTORY PLEASE READ CAREFULLY The information provided above is a complete and accurate statement of any physical and psychological conditions, which may affect my participation in this tour. I am aware that failure to disclose such information could result in serious harm to me, and my fellow participants. I agree to inform the Operator or their tour guide, should there be any changes in my health status prior to the start of the activity or during the tour. Based on the background information at the beginning of this form, and what I know or suspect about my physical and psychological health, l am fully capable to participate this Canyoneering trip. I understand that if have the potential for a severe allergic reaction to bee stings, insect bites, food or other substances that might be found in the outdoor, it is my responsibility to bring medication/s with me on this tour. Participation in Canyoneering adventure exposes one to many hazards, including the risk for severe injury and may even cause death. The tour guides strives to manage these risks, but many of these risks are beyond their control. Some of the inherent dangers and risks that may be presented includes but are not limited to, the following: 1. Accidents, illness, or other problems in remote places without cell/mobile phones, other means of communication or easy access to medical facilities. 2. Travel in a vehicle driven by a person other than self. 4. Forces of nature including lightning, storms, wind, rain, heat, weather changes, and (sudden) changes of water levels. 5. Wounds and injuries to the skin, organs, muscle, joints, and bones. 6. Injuries inflicted by animals, plants, UV rays, or other natural forces. 6. Physical exertion associated with the movements involved with Canyoneering adventure activities that can cause fatigue, soreness, joint stiffness, and the most common, blisters. 7. Problems arising from the improper use of the safety gears. 8. Hazards related to water including wading, swimming, or capsizing into water containing cold temperatures, rocks, trees, currents, rapids, re-circulating holes, waterfalls, man-made structures, or other obstacles in the water. This can result in hypothermia, injury, entrapment, or drowning. 9. Lost baggage or personal belongings due to negligence, thievery, or other similar acts.I agree to follow the tour guide's safety procedures and instructions and to avoid unnecessary hazardous situations, whether those situations have been specified.I fully understand the dangers or participating in the CANYONEERING adventure which poses high risk for severe injuries and even death.I for myself, my heirs, executors, administrators, and assigns, hereby release and forever discharge the Operator and any Tour Provider.I hereby affirm that I have FULY UNDERSTAND the above and AGREE to be legally bound by it.I ALSO AFFIRM THAT I AM ABOVE 18 YEARS OLD OF AGE. If under 18 years old, a parent or guardian's signature us REQUIRED.Date of AdventureParent/Guardian NameI agree to the Privacy PolicyYour health data is used strictly for safety and emergency response during the tour. We ensure all equipment meets professional standards and only share information with medical personnel if needed. Your data is never sold or used for marketing.Submit