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Risk & Emergency Contact Form

 

​Peer Specialist | Immersive Resilience Training with Real-World Safety

Challenger Point Practice PLLC – Ad Astra Per Aspera

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Why This Form Matters

This isn’t your average waiver. The Risk & Emergency Contact Form is how we ensure that every scripted arc—whether in the ocean, hot springs, high desert, or summit—is done with trauma-informed, medically sound, and operationally safe protocols in place.

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We’re not asking if you’re perfect. We’re asking how we can keep you alive, regulated, and build resilience while we help you reclaim your nervous system.

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This form is for anyone entering:

  • Cold water or hot spring resets

  • Rolling, crawling, and movement-based trauma drills

  • Navigation through a variety of terrain

  • Group environments that might trigger panic or withdrawal

  • Remote field settings with limited immediate care

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What This Form Covers

  • Emergency contact info in case of incident

  • Health risks like seizures, heart issues, Posttraumatic Stress Injuries, diabetes, or severe anxiety

  • Known triggers or safety concerns in outdoor or group environments

  • Medications, medical devices, mobility considerations

  • Altitude or aquatic concerns

  • Any personal safety planning we need to be aware of

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Your completed form is held confidentially. Only your assigned CLIMB Medical Team (Peer Specialist, Licensed Mental Health Professional, PCP/PCM) will have access.​​ Everything follows HIPAA and 42 CFR protections. We’ve got your six.

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What If I Have a Condition?

We expect you to. That’s why you’re here.

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  • You can still float with past trauma

  • You can still do breath work with asthma (we modify everything)

  • You can still hike even if you’ve been on the couch for a decade

  • You can still be part of CLIMB with panic history, meds, or medical devices

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We just need to know the field risks before we enter the field. That’s it.

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We’re Not Here to Exploit You — We’re Here to Watch Your Back

 

Peer Specialist training is built by first responders, military veterans, and trauma clinicians. We know what it feels like to be overexposed and under prepared. This form makes sure we don’t make that mistake with you.

We prep. We train. We check in.

This isn’t therapy in a chair. It’s therapy in the wild. And we respect it accordingly.

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Download the Form

 

📄 [Download 2.3 – Risk & Emergency Contact Form (PDF)]
🖊️ Submit CLIMB Intake Form

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Submission Details

You can return this form securely via:

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📧 Email: matthew@challenger-point.com
📠 HIPAA-Compliant Fax: 970-360-1011

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What Happens Next?

We’ll use this form to:

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  • Prep your Peer Specialist and Clinical Team

  • Modify your trauma reset track based on safety

  • Ensure we’re ready if a medical or emotional crisis occurs

  • Offer the most supportive, ethical, and effective CLIMB experience possible

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CLIMB Isn’t Just a Program. It’s a Lifestyle.

If you’re reading this, you’re already part of the mission. Complete the form. Let us carry the risk planning so you can carry your story toward strength. You move—we’ve got you.

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