Pre-Clinic Questionnaire

Pre-Clinic Questionaire

Thank you for choosing HARDWATER KITING.
To better assist you in meeting your snow kiting goals we ask that you fill out the following questions.
If you have any questions regarding this form please let us know.
Be advised the information supplied here will be kept confidential.

Name/Address.

* Indicates required field

Name *

First

Last

Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone *

Passport or License Number *

Emergency Contact *

Emergency Contact Phone *

Height *

Weight *

Age *

Gender *

Current Fitness Level. How often do you exercise? *

Ski/Board/Kite Experience.

Skier or Snowboarder? *

Skier/Boarder Level (Choose one) *

What is your level of Kite Sport experience? *

What other sports do you participate in? *

Medical/Surgical history.

Do you have surgical or orthopedic incident history? *

Do you have a permanent condition. (e.g. asthma, etc.) *

If "Yes", please describe. *

Are you currently taking any medications (prescription or over the counter)? *

Is there anything else in your medical history that your instructor should be aware of? *

If "Yes", please list them. *

If "Yes", please describe. *

In your own words. What is your goal in taking this clinic? *

Submit