Online Reservations

Please note that many of our programs take place in remote settings, where rescue may be difficult and definitive medical care can be far away. We use the information on this form to help us be sure that you have signed up for an appropriate trip with respect to your experience and ability level; and to aid us should a problem arise. In addition to filling out this form completely, we ask that you speak with one of our staff to help match your goals, physical conditioning, and experience to a trip which is appropriate for you. For some trips, you may be asked to consult a physician. Thank you for taking the time to provide us with complete information.

Trip Name: *
Rock Climbing Skills Day
Select a Trip Date *
Trip Time:
First Name: *
Last Name: *
Address: *
City: *
State: *
Zip: *
Cell Phone: *
Home Phone:

Please describe relevant prior experience: (hiking, backpacking, fitness, travel, etc.)

Please list any medical conditions that we should be aware of while you are on this trip (i.e. heart conditions, asthma, prior injuries, etc.) as well as any medications you take and reason for taking them:

Please list all allergies including food borne allergies. In addition to allergy information, on some trips, but not all, we can cater to certain diets: Are there any dietary requests that you would like to mention at this time?

Any additional questions or information, comments, and/or goals for your trip:

Other Accessories

Harness - waist Size

Rock Shoes - street shoe size

Helmet

Email: *
Birthdate: *
Approx. Height & Weight: *
Gender:
Emergency Contact Name: (someone not on this trip)*
Emergency Contact Phone: *

How did you hear about SYMG?
Please enter no. of additional travelers

Trip Payment Information

Please bill my credit card

Full Trip Amount

Deposit, bill balance at 90 days
Card Number:
Expiration Date:
/
Credit Card CVV Number:
(3 numbers on back of Visa/MC/Disc or 4 on front of Amex cards)
Name as it appears on Credit Card/Signature.
Billing Address
Same as above

Address:
State:

City:
Zip:

I have read and understand the reservation and cancellation policies described in SYMG's Terms and Conditions

All information on this form is personal and confidential. Other than correspondence between you and SYMG, your information will not be shared with other parties.

I have read and understand the Participant Agreement, Release, Acknowledgement of Risk and agree to be bound by its terms. Please note here that if you listed more than one person on the same form that a check mark indicates that you are agreeing to the terms for everyone on this form: husbands, wives, children etc.

This form may be submitted electronically, or you may print it out and mail it to SYMG ATTN: Reservations, 42997 E Mountain View Ln, Oakhurst CA 93644. Please note that you will be notified by e-mail once we've received your electronic form. Thank you.

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