Medical Declaration & Insurance Waiver Form

Your health and safety on the trail

This form helps us ensure your safety while trekking in the Andes. You are required to complete this Medical Declaration & Insurance Waiver Form no later than when you make your balance payment. You may be denied participation in your tour or trek if you do not complete this form by that time.

We strongly recommend purchasing comprehensive travel insurance for your trip. Medical coverage from your home country typically does not apply abroad; in addition, a good policy can also protect you against unexpected trip changes or cancellations. For more details on why travel insurance is essential, check out our blog.

If you have a medical condition or require special accommodations, we will provide a letter for your doctor to complete.

Review all information carefully before submitting.

Medical Form

Medical Declaration & Insurance Waiver Form

Name

Trek / Tour

Departure Date

General Warnings

No sophisticated medical facilities are available in the Andean region. This Tour / Trek is intended for persons in reasonably good health and fitness.

Passengers who are not fit for long trips for any reason, who have a serious heart or other health condition, knee problems, or who are more than 18 weeks pregnant, should not participate in a Trek or multi-day hike, but can participate in a non-trekking Tour. Should any such condition become apparent, we reserve the right to decline to accept or to retain you at any time during the trip.

In addition, you are advised to carry your own regular medication as it may not be available in Peru. We recommend travelling with this medication in your carry-on in the event of misplaced luggage by the airline; syringes will not be allowed in carry-on bags. Clients are further advised that medical evacuation, if available, is expensive, and we strongly recommend that you have medical insurance that will reimburse you for this cost.

Important: We do not require these forms to be completed prior to booking, but if you make a booking and your doctor completes Part III indicating that you are unfit for the trek you have selected, Apus Peru reserves the right to not accept you for the trek. Please note that in this case your deposit is non-refundable.

Part I: Health Statement & Insurance Waiver

1. General health & fitness

I attest that I am in good general health, of excellent fitness, and am capable of performing normal activities on this Trek or Tour. If not, I have or will embark on a fitness program designed to prepare me for a high-altitude trek. This might include walking 5-8h per day in hilly terrain or up and down stairs, if there are no hills where I live.

2. Trek information

I have read and understood the information on the website describing the Trek or Tour I have booked, taking particular note of the difficulty level and hours of walking per day. Remember – no trek in the Andes is easy!

3. Children

For children and youth under 16, parents or guardians confirm that the child has the resilience and stamina to manage the trek difficulty. Parents or guardians further confirm that they will have taken the child for back-to-back days hiking at least 5h per day, camping overnight in between.

4. Acclimatization

I understand that high altitude affects people differently, but may increase heart rate or blood pressure, cause shortness of breath, headaches, dizziness, general unease and/or loss of appetite. I understand that sufficient acclimatization prior to beginning any trek is essential and that the minimum acclimatisation period for all treks is 2-3 full days (48-72 hrs), but this is less than ideal.

5. Medical conditions and treatment

I understand that this Trek or Tour will take me far from the nearest medical facility and that all trip members must be self-sufficient. With that understanding, I certify that I have not been recently treated for, nor am I aware of, any physical or other condition or disability that would create an impediment to myself or other members of the group completing the trip enjoyably.

6. Comprehensive Travel Insurance

Apus Peru strongly recommends that you take out comprehensive travel insurance that includes coverage for trip interruption or cancellation, as well as a medical component, and specifically covers adventure travel. Read more about why comprehensive travel insurance is essential in our blog.

Have you taken out travel insurance?

Please confirm that you understand that you are responsible for all medical, cancellation or change of route costs.

Name & Number of Policy:

If you do not have insurance, please complete the following waiver:

I recognize the risks of participating in a tour or trek with Apus Peru Adventure Travel Specialists and assume responsibility for all associated costs in the event of trip interruption or cancellation, in accordance with Apus Peru Adventure Travel Specialists, and assume responsibility for all associated costs in the event of trip interruption or cancellation according to Apus Peru's Booking Conditions. In case of the need for medical attention, I understand that I will be responsible for all costs associated with receiving medical attention, including but not limited to, doctor’s visits, x-rays and laboratory tests, medical equipment, hospital stays, evacuation, and repatriation fees.

Full Name

Date of Tour/Trek

Yes, I agree to assume responsibility for the costs of potential changes, cancellation or medical attention

Part II: Medical Information

Date of Birth

Blood type (if known)

Height

Weight

Medical & Health Information

Evaluate your general health

Evaluate your physical condition

Are you an asthma sufferer?

If you suffer from asthma, it is essential that you visit your doctor prior to your trip. During your Tour / Trek you will be at high altitudes, in areas that can be very cold, very dry or very humid, and where animals are present. Please ensure that your doctor is aware of this and that you travel with the appropriate medication for your condition.

Are you an ashma sufferer?

Do you have any medical illnesses, disabilities or infirmities that have required the regular care of a doctor? If you are treated regularly by a doctor, please also include their name and contact number.

List all medications you are currently taking, including dosages and contraindications.

Do you have any heart or respiratory problems? Are you a diabetic? Please elaborate.

Do you have any dietary restrictions, food or drug allergies? If so, what are they?

Do you have any physical or mental limitations, handicaps or prosthesis? Are you pregnant?

Part III: Emergency Contact Information

Please provide the contact details of the person we should reach out to in case of an emergency.

Name of Emergency Contact

Relationship

Phone/Mobile of Emergency Contact (please include the country prefix, e.g., +1 123 456 789).

Part IV: Medical Advisor’s Opinion

If you meet any of the criteria listed below, you will be required to have your personal physician review your itinerary and sign a letter (which we will provide) confirming your ability to participate in the trek.

You will also be required to obtain travel medical insurance and be accompanied by a trekking companion on the trek at all times who will trek by your side and be familiar with any medicines required in case of an emergency.

Please select all of the conditions which apply to you

Thank you for confirming that one or more of the listed medical conditions applies to you. Your Travel Consultant will provide you with a letter to review with your doctor.

Your health and safety on the trail

Medical Declaration & Insurance Waiver Form