| ■Course name |
| Snow Self-discovery 7 Days Dates: March 1 – March 7, 2024 |
| ■Participant information |
| Family Name※ |
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| Given name※ |
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| Email Address※ |
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| Gender※ |
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| Date of Birth※ |
Year
Month
Date
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| Height of body /cm |
cm * |
| Weight of body/ kg |
kg * |
| Foot Size/cm |
cm * |
| Blood type |
* RH
|
| Emergency Contact*. |
／
(Other than yourself). |
| ■Health Conditions |
| １．Please fill in the blanks about your usual situation. |
Normal body temperature
℃*
Pulse rate at rest
／per minute*
Visual acuity (naked eye) right
left
*
|
| ２．Please indicate your physical condition and constitution if applicable. |
Food allergy (kind of food and symptoms)
Other non-food allergy (to what and how the body reacts)
I have a medication that I take regularly.(name of drug and effects)
There are certain drugs that should not be used (drug name)
Prone to back pain (when and how)
Joint pain (where and when)
Prone to anemia (when it happens)
I sometimes have asthma attacks (when and how you deal with)
Prone to hyperventilating (when and how you deal with)
I have been allergic to bee or insect stings (when and what stung you?)
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| ３．Please indicate any illnesses or injuries that you are currently treated. |
What type of illness or injury?
Are there any restrictions on lifestyle or exercise? What are they?
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| ４．Please indicate any illnesses or injuries that have required exercise restrictions. |
When and what type of injury or illness?
What restrictions were there? →How about now?
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| ５．Please indicate your medical history if any. |
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| ６．Please indicate if you have ever received a physical disability certificate and a disability certificate. |
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| ７．Please inform us of any other current health problems or concerns. |
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| ■About the course to participate |
| １．What are your expectations? |
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| ２．What are your concerns? |
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| Confirmation* |
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| ■Other |
| About Rental items* |
Rental of Gore-tex rain gear (3,000 yen)
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| Transportation to the site* |
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