COSLEY and HOUSTON ALPINE GUIDES

151 Route de Lausenaz • 74310 Les Houches, France
www.cosleyhouston.com • +33 450 21 24 47

2019 Program Application and Registration
Private Climbing Programs

Use this form for booking a climbing program with us. Also please complete our Emergency Contact form.

If you prefer to download a blank PDF copy of these forms, and fill them out by hand, you can find them here.
Registration form

Emergency Contact form

Important!

In an effort to avoid spam responses to this form, we ask you to answer one simple question. The wrong answer will move your response to our trash.

What is Kathy and Mark's country of residence? 

Hint: It is not the United States! Another hint: It rhymes with "pants". Still don't know? Look at the address above.


first name
last name:
address:
city:
state/prov:
postal code:
country:
mobile phone:
home or work phone:
email:
program name:
(you can approximate)
program dates:
total trip fees:
(if you're not sure, leave this and the next fields blank)
deposit amount:
(usually 25% of total fees)
balance due:
(total less deposit)
due date:
(enter a date 60 days before the start of the trip)

Deposit and Payment Schedule for Private Ski Programs

In order to secure your place in a program a deposit of 25% is due at the time of registration. We cannot hold your place without this deposit. The balance of the trip fees is due 60 days prior to the starting day of the trip. This is the balance due date. For registration after the balance due date, full payment is due at the time of registration. If full payment is not received by the balance due date and other arrangements are not made with us, we reserve the right to consider your registration canceled.


Cancellation and Refund Policy

If you cancel your enrollment for any reason the following policy applies:

• If you cancel 60 days or more before the balance due date, you will receive a refund of all payments and deposit.
• Cancellation occurring after the 60 day balance due date will result in a complete forfeiture of all fees.


Trip cancellation, Interruption and Emergency Evacuation Insurance

In order to protect yourself from the loss of nonrefundable fees we strongly recommend you purchase trip cancellation insurance. This type of insurance will allow you to recover fees resulting from cancellation due to personal or family illness occurring before or during your program.


Conditions of Participation

There are a number of conditions required for participation in our programs. These include, but are not limited to agreement with, and understanding of the cancellation and refund policy outlined above.


I have read and agree to the conditions of the Cancellation and Refund Policy.
Yes No


Previous Experience and Medical Information

The completion of this portion of your application form helps us in helping you to maintain good health during your trip by alerting us to special medical requirements and concerns you may have, and it helps us in our general goal of reducing risk while maximizing and realizing your personal potential.

1. Food or insect, etc. allergies? Please describe. If you have a serious known allergic reaction we strongly recommend you carry an anaphylaxis kit.
2. Are you allergic to any medications? If yes, please describe the, medication, nature and severity of your allergic reaction.
3. Do you have a history of asthma?
4. Have you ever had any joint injuries? Please describe. Specifically, have you had injuries to knees, ankles or shoulders?
5. Will you be taking any medication during this program that we should know about? If so, please describe.
6. Has altitude illness ever caused you significant discomfort, or prevented you from achieving climbing or skiing goals? Please describe the circumstances.
7. Are there any medical or physical conditions which might limit or affect your participation in this program? Please describe.
8. Do you have any special dietary requirements?
Date of Birth: year month day
Height:Weight:

Outdoor Activity – Skiing and Climbing Experience
1. Please give us a brief description of your current physical condition.
2. Describe your current level of regular exercise. We would like to know what activities you engage in, your history of involvement in those activities, how frequently you practice them, and for how long.
3. Skiing or climbing history. If it is extensive, highlights showing length of involvement and diversity will do.
4. If you have been skiing or climbing with us before, please remind us of how the trip went for you, and the degree of success in achieving your objectives.

Print for you records?
Click to send the completed
registration to us as an email.
Clear the form?
Questions? phone in France +33 450 21 2447
email: kathyandmark@cosleyhouston.com

IFMGA Mountain Guides
AMGA Certified Guides