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Overnight Climb Form

Name

Mobile number / WhatsApp

Weight (kg)

Height (cm)

Birth date

Gender

Nationality

Passport number

Date of arrival

Date of departure

Date you want to climb

Preferred time of the day

Do you have any kind of disability?

Which physical activity or sport(s) do you practice?

How often do you perform physical activity?

Have you ever climbed a mountain? If you did, please indicate which.

What was the most demanding activity you performed?

Please let us know the distance in Kilometers and the altitude difference in meters (if possible, the accumulated difference that involves going up and down).

What are your strongest physical and psychological characteristics?

Have you ever used walking sticks?

Yes No

In the hiking activities you’ve done, have you ever carried a heavy backpack weighing around 10 to 15 kg with an average pending trail between 20% and 30%?

Do you intend to train/prepare or have you trained/ prepared to climb Mount Pico?

Do you take any medication regularly?

Yes No

If so, what for?

Do you have any physical restrictions?

Yes No

If you do, please indicate which one.

Do you have any surgery on the lower limbs, for example knee, ankle or foot?

Yes No

If you do, please indicate us where and how long has been since the surgery.

Are you afraid of heights or vertigo?

Yes No