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College Outdoors

Health & Diet Questionnaire

The following information is for our trip leaders’ file only and remains strictly confidential.  

It is critical to fill out the health and diet questionnaire thoroughly indicating all current medications, past injuries, and any present conditions.  Failure to do so could put yourself or other students at risk.  

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(For New Student Trip registration, "NST" is sufficient)
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(i.e. 5ft 6in)
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(i.e. 135lbs)
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For example, he/him, she/her, they/them
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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If you answered "yes", please describe in detail in the space provided below.
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Note: Due to the nature of outdoor trips and the distance and time to definitive medical care, we may (in the case of medical conditions that could put you at serious risk in a remote setting) ask you to discuss the trip you're applying for with your physician for their advice and require their permission to place you on the trip.
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If no, please either complete the information below (some fields may not apply), email a scan of both sides of your card to outdoors@lclark.edu, or, if you are on campus, bring your medical insurance card to the College Outdoors office in Templeton 244.
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There's an additional $5/day charge to provide vegan meals or special diets such as gluten free meals for New Student Trips in August. This fee IS waived for any medically-based allergies or intolerances. We may ask you to send us a note from your health care provider. Vegan and gluten-free meals are not available for all trips, please check the trip descriptions.
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