Yellowstone Wolf Tracker






















Participant Questionnaire


First Name
Last Name
Street Address
Address (cont.)
Zip/Postal Code
Home phone #
Traveling Phone #
Airline/flight #/arrival time
Airline/flight #/departure time
Profession (past or present)
Hobbies or special interests
Have you been to Yellowstone before? yes   no
How many visits to Yellowstone?
How did you hear about our programs?
Diet & Food Preferences

Generalist     Vegetarian     Vegan    No red meat

Food Allergies or Diet Restrictions?

AM Beverage:  coffee  decaf coffee  tea  decaf tea  cocoa

PM Beverage:  red wine white wine  beer  soft-drink

Any Favorite Snacks or Beverages (water provided)

Health Information


male   female




  Emergency Contact / phone number:

Please describe your fitness level, e.g., physical activities in which you engage (times per week, duration, and level of intensity):


SEVEN-QUESTION HEALTH QUESTIONNAIRE:  It is important that your trip leaders are alerted if you have a conditions that could be aggravated by long, strenuous days, or by the outdoor environment.  By obtaining some basic but pertinent medical information from you, we hope to minimize the potential for medically related emergencies.  If you respond with a “yes” to any question below, it does not mean you will not be allowed to participate. You can, however, expect us to speak with you about how your condition has the potential to be negatively affected by local environmental factors or program activities. You should also be aware that advanced medical support is often hours away. All information provided on this questionnaire will remain confidential and will be reviewed by staff only.

1.  Have you experienced an asthma attack at any time in your life? (Asthma can potentially be affected by exercising at Yellowstone ’s high elevation; dry, dusty air; and wildfires)

yes   no

If you answered yes to question one, please answer the following as well:

*      · Have you visited the emergency room because of your asthma in the last year?

yes   no

*      · Have you had to use epinephrine following an asthma attack in the last year?

yes   no

*      · Were you diagnosed with asthma in the last year?

yes   no

*      · How often do you use your inhaler to treat your asthma or wheezing?

*      ·  Anything else you think we should know about your asthma:

2. Have you ever been diagnosed with type I or type II diabetes? (A diabetic can easily become dehydrated in Yellowstone ’s very dry environment; long, arduous days/hikes can lead to hypoglycemia)

yes   no

If you answered yes to question two, please answer the following as well:

*      · Have you visited the emergency room because of your diabetes in the last year?

yes   no

*      · Do you have numbness in your feet or poor circulation due to your diabetes?

yes   no
*      · Were you diagnosed with diabetes in the last year?  yes   no

*      · Anything else you think we should know about your diabetes:

3. Have you ever visited a medical professional for a serious allergic reaction, or have you ever been given a shot of epinephrine for an allergy or anaphylaxis?  (Some people are allergic to the following: stinging insects found in Yellowstone ; iodine- used to treat drinking water and/or clean wounds; drugs used to improve acclimatization at altitude.)

yes   no

If you answered yes to question three, please answer the following as well:

*      · Have you had a serious allergic reaction in the last year?

yes   no

*      · Have you ever been given epinephrine because of your allergies or anaphylaxis?

yes   no

*      · Has your anaphylaxis been worsening over time?

yes   no

*      · Do you also have a heart condition or a history of high blood pressure?

yes   no

*      · Anything else you think we should know about your allergies or anaphylaxis:

4. Have you ever received medical treatment for angina, a heart attack, or any type of heart disorder/disease? (High altitude puts a strain on the heart, and the altitudes at Yellowstone , combined with the hiking, will almost certainly increase the heart rate of the average visitor.)

yes   no

If you answered yes to question four, please answer the following as well:

*      · Are you able to exert for long periods without experiencing angina pain?

yes   no

*      · Do you currently have congestive heart failure?

yes   no

*      · Have you been hospitalized within the last year because of a heart condition?

yes   no

*      · Anything else you think we should know about your heart condition:

5. Have you ever been diagnosed with or are you currently being treated for high blood pressure? (Altitude can affect blood pressure, and the environment and physical activity associated with our programs may affect the efficacy of some blood pressure medications.)

yes   no

If you answered yes to question five, please answer the following as well:

*      · Is your blood pressure currently under control?

yes   no

*      · Is your systolic blood pressure generally under 140?

yes   no

*      · Anything else you think we should know about your blood pressure:

6. Have you ever seen a medical professional following a seizure, or are you currently being treated for any type of seizure disorder? (Some seizures are triggered by fatigue and dehydration [which can occur following a long hike], significant change in diet, low blood oxygen [which can occur at altitude])

yes   no

If you answered yes to question six, please answer the following as well:

*      · Are you currently taking medication for your seizures?

yes   no

*      · Were you diagnosed with a seizure disorder in the last year?

yes   no

*      · When is the last time you had a seizure?

*      · Anything else you think we should know about your seizure disorder:

7. Is there anything else we should know about your medical background? (I.e., anything that could affect your safety or ability to participate fully?)

Regarding Medications:

Certain medications have the potential to increase the risk of harm to Yellowstone visitors. For example, some drugs affect a person's ability to deal with hot/cold, while other medications can affect the body’s ability to cope with trauma (e.g., Coumadin [Warfarin], a drug commonly used to address heart disease, affects the body’s ability to stop bleeding). 

If you are taking any type of over-the-counter or prescription medication, we encourage you to talk to your physician before coming on the trip. Please review all of the drug’s potential side effects in order to determine whether or not the medication could affect your well being or ability to participate.  PLEASE indicate any medications that may affect your participation, reasons for taking, and potential side effects here:


Medical Release:  

By submitting answers to these questions, I am declaring that, to the best of your knowledge, I have completed the questionnaire accurately. I also understand that by knowingly filling out the form inaccurately, or by withholding pertinent information about health, I could potentially be increasing the risk to yourself or others.  I affirm that my general health is good, that I am in good physical condition, and that I am not affected by moderate exercise at high altitudes.  

I understand and agree that I am participating in the above trip voluntarily and at my own risk.  I realize there is inherent risk in outdoor activities and will not hold The Wild Side, LLC, or its affiliates liable for any accident that results in personal injury, death, or property damage during or in connection with the trip.  I hereby release and forever discharge The Wild Side, LLC, and its directors, officers, and employees from all such claims.   This waiver will be construed according to the State of Montana.  Any disputes will be governed under Montana law and the venue of any action shall be in Bozeman, Montana.

I hereby give my permission for The Wild Side, LLC, to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of The Wild Side, LLC, and grant permission to its representatives to authorize any competent medical person to do all things reasonably necessary to take care of any injury or sickness.  There is no health insurance or medical coverage provided.  The acceptance of these terms acknowledges that the participant/guardian accepts responsibility for payment of any medical treatment, which may be required, while they are on this trip.   

Accept      Decline


Terms and Conditions:

Cancellation Policy:  A full refund of the deposit (minus $45 processing fee) will be given for all cancellations more than 60 days before the trip. For cancellations less than 60 days before departure, the deposit is non-refundable. We cannot refund money for missed meals, missed portions of the trip or any other unused portions of the tour. Cancellations must be submitted in writing and are effective upon date of receipt.

Health and Safety:  Trip participants must fill out a medical waiver and a liability waiver.  The trip requires average physical fitness and is suitable for people of all ages. If you have health questions, consult your doctor for more information. The tour leaders must be advised in advance of any special health needs. Weather conditions can change without notice and it is the responsibility of the traveler to have proper clothing and equipment. Please contact our office for assistance in what to bring on the trip.

Responsibilities and Conditions: The Wild Side, LLC acts only in the capacity of agent in all matters of transportation and tour operation.  They are not responsible for delays, inconveniences, accidents, expense or mishap of any kind whatsoever resulting entirely, or in part, from the negligence of others or from causes beyond their control.  They can accept no responsibility of losses or additional expenses due to delay or changes in air or other services, sickness, weather, strike, war, quarantine, or other causes.  All such losses or expenses will have to be borne by the participant, as tour rates provide for arrangements only for the time stated.  The right is reserved to substitute accommodations or modes of transportation and to make any changes in the itinerary where deemed necessary or caused by changes in transportation schedules.  The Wild Side, LLC take no responsibility for special arrangements or problems incurred by persons physically unable to participate in the planned activities.  No refund can be made for absence from the tour unless arrangements are made at the time of the booking.  The right is reserved to decline, to accept or to retain any person as a tour member for any reason which affects the operation of the tour or the rights and welfare or enjoyment of the other tour members.  The Wild Side, LLC, will not discriminate against any individual because of race, sex, creed or nationality.

Firearms Policy:  Possession of firearms are not allowed on any The Wild Side, LLC, program.

Canceled Trips: The Wild Side, LLC, reserves the right to cancel any trip should an inadequate sign-up make the trip economically unfeasible for us to operate or should conditions arise beyond our control that adversely affect the well-being of the trip members.  In such a case, a full refund of the trip cost is given, but The Wild Side, LLC, is not responsible for additional expenses incurred by members in preparing for the trip.

Acknowledgement of Risk:  In consideration of the services of The Wild Side, LLC, business (hereinafter collectively referred to as TWS) their officers, agents, employees, and stockholders, and all other persons or entities associated with that, I agree as follows:  TWS has taken reasonable steps to provide me with skilled guides so I can enjoy an activity for which I may not be skilled, TWS has informed me this activity is not without risk.  Certain risks are inherent in each activity and cannot be eliminated without destroying the unique character of the activity. These inherent risks are some of the same elements that contribute to the unique character of this activity and can be the cause of loss or damage to my equipment, or accidental injury, illness, or in extreme cases, permanent trauma or death.  The following describes some, but not all, of those risks:


*       the nature of the activity itself,

*       hiking off roads and trails,

*       skiing or snowshoeing off roads and trails,

*       moving on foot around wild animals,

*       weather including rain, snow, lightening, and wind,

*       high altitude,

*       vehicular travel, and vehicles not associated with this program


   I am aware that participation entails risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. I agree to assume and accept full responsibility for the risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks.  I acknowledge that the staff of TWS has been available to more fully explain to me the nature and physical demands of this activity and the inherent risks, hazards, and dangers associated with this activity.  I certify that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody, and control, for bodily injury, death, or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and, as a result of my negligence in participating in this activity.  I have carefully read, clearly understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative and estate and for all members of my family, including minor children (under 18 requires signature of parent or guardian).


Informed Consent:  I have been fully advised of the potential risks involved in participating in this trip.  I enter into this agreement freely and by ACCEPTING I agree to the terms and conditions, participant waiver, medical release, firearms policy, and acknowledgement of risk.

Accept      Decline


Validation Field:


No SPAM !  We will not pass on your information.