Absaroka Beartooth Outfitters - Montana Hunting and Fishing Above The Rest

ABSAROKA-BEARTOOTH OUTFITTERS MEDICAL INFORMATION FORM

Name

Emergency Contact

Telephone of Emergency Contact

Insurance Information

Are there medical issues that Absaroka-Beartooth Outfitters, EMS, or medical physicians attending your emergency care need to be aware of?

Yes No

Examples: Allergic reactions to drugs, foods, insects, plants, etc., Heart conditions, Physical limitations

If yes, please list

Are you currently using medication?

Yes No

If yes, please list medications and dosages

If a medical emergency occurs, I hereby grant permission to be transported if possible to the nearest medical facility. I hereby release Absaroka-Beartooth Outfitters, guides, and agents from any claims resulting from any injury or accident.

Date	Participant/Legal Guardian

Absaroka-Beartooth Outfitters • P.O. Box 318 • Big Timber, MT 59011• (406) 579-3866 • email
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