Make sure to sign a medical digital waiver if you want to live and work on a mountain.

Sunshine Village Corporation

Staff Lodges - Medical Information Form

Living and working on-mountain is an amazing experience! However, a high altitude, remote environment may present health challenges. Certain medical conditions can onset much faster at elevation - plus, the longer response time to definitive medical care could put your health and wellness in jeopardy.

If you are planning to live and/or work on-mountain, Please answer the questions below. Read each question carefully and provide any relevant details. Your information will be kept confidential and will only be used to assess the suitability of your living on-mountain, or to assist in the context of a health-related emergency.

Please fill your name: *

Please enter your full name.

Date of Birth: *

Please enter valid date.

Phone number: * Please enter your phone number.

Email: * Please enter your email.

Department: * Please enter your answer here.

Provincial Health Care # if applicable: Please enter your answer here.

Travel Insurance? Please enter your answer here.

Emergency Contact : * Please enter your answer here.

Phone number: * Please enter your phone number.

It's important to check with a doctor before starting work on-snow, or moving on mountain if you answer YES to one or more of the questions below.

Previous history of concussions *

Yes

No

Please select at least one choice above.

Previous history of fainting *

Yes

No

Please select at least one choice above.

Epileptic or history of seizures *

Yes

No

Please select at least one choice above.

Heart Condition *

Yes

No

Please select at least one choice above.

Surgery or hospitalization within the last year *

Yes

No

Please select at least one choice above.

Pre-existing injury (back,knee,hip) , bone/joint condition *

Yes

No

Please select at least one choice above.

Shortness of breath or chest pain during physical activity *

Yes

No

Please select at least one choice above.

Diabetic *

Yes

No

Please select at least one choice above.

Medication *

Yes

No

Please select at least one choice above.

Allergies *

Yes

No

Please select at least one choice above.

Wears a medic alert bracelet or necklace *

Yes

No

Please select at least one choice above.

Glasses or contact lenses *

Yes

No

Please select at least one choice above.

Hearing Problem *

Yes

No

Please select at least one choice above.

Asthma *

Yes

No

Please select at least one choice above.

Please provide any relevant details if you answered 'YES' to any of the above items: Please enter your answer here.

Medications, Allergies, Medical Conditions (please list, including if you carry an Epi-Pen): Please enter your answer here.

I Have read, understood and completed the above to the best of my knowledge. I will update my Supervisor or the Staff Lodges Supervisor (or designate) with any relevant changes.

I understand that Sunshine Village reserves the right to reassign or remove my place in on-mountain Staff Accommodation if, in their sole opinion, maintaining a place of residence on-mountain may jeopardize my own health and safety or the health and safety of others.

Your signature *

Click to sign

Please sign here.