Your Emergency Info

In the event of an accident or emergency, your personal vital information is critical. It aids your partners or rescuers in assisting you. Being prepared for the unexpected is part of being a responsible climber. I've constructed a sample list of information that can be very important to those you climb with and those who may be trying to save your life in an emergency. Keep a copy of this form in an accessible place while you are climbing. I keep one in my helmet and a second copy in my wallet.

Name: ____________________________________________
Weight:__________
Allergies:___________________________________________
Important medical information:__________________________________________________
___________________________________________________________________________
Hair color: _____________
Eye color::______________

Full Address:__________________________________________________________________
Home Phone:_______________________________
Cell Phone:_________________________________
Work Phone:_______________________________
Employer: Address / phone_______________________________________________________

First Contact:
Relationship:_____________________________
Name:__________________________________________________
Phone:____________________________
Cell:_______________________________
Address:_________________________________________________________________________
Employer: Address / phone __________________________________________________________

Second Contact:
Relationship:_________________________________
Name:______________________________________
Phone:______________________________________
Cell:________________________________________
Address:_________________________________________________________________________
Employer: Address / phone__________________________________________________________

Physician / Hospital medical records __________________________________________________

Insurance: policy #__________________________________ group#________________________

Additional Comments: i.e., advanced directives, health care surrogate: ________________________
_______________________________________________________________________________