College Expeditions Enrollment Form

College Expeditions Enrollment Form

Please give thought to each answer so that we can get to know you better before your trip. The La Vida staff use this form to place you in a group. We will follow up with you on any food or medical needs you might have.
First Name*
Last Name*
Nickname
College ID number (Please ensure correct entry so we can match your record.)*
Gordon Email
example@example.com
Personal Email (if you have not been assigned a Gordon email yet)*
example@example.com
Household/parent or guardian email
example@example.com
Sex*

MaleFemale
Age*
Birth date (mm/dd/yyyy)*
Year in college at time of registration*

IncomingFreshmanSophomoreJuniorSenior
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Course preference and availability for PED016 2023. Please note the August trip may be split into two departure dates to accommodate the number of students. You will be notified of your departure date after you apply. International Students are strongly recommended to sign up for August expedition to ease travel logistics.*

June Trip 6/20-7/1 (incoming and current students)July Trip 7/4-7/15 (incoming students only)Late July Trip 7/18-29 (incoming students only)August Trip 8/6-17 (incoming students only)
Specific trip type request (The primary mode of travel for "Mountain" is hiking on trails. The main mode of travel for "Canoe" is on the water. )*

MountainCanoeAny
Reason for trip type request:
Height*
Weight*
Major*
Extracurricular activities:*
How did you hear about and decide to register for this expedition? What is the main reason you want to go on the trip?*
Most students have never camped before La Vida, but if you have any previous camping, hiking, or canoeing experience, please let us know:*
What three words best describe your temperament?*
What three goals would you hope to accomplish during your La Vida experience?*
La Vida highly values community and the input of each individual in the group. What gifts, talents, values, etc., would you bring to your La Vida small group?*
Are you taking any prescribed medications? Please list the medication and reason for taking it. Do you anticipate any change in medication or dosage for your expeditions?*
Do you have any allergies or dietary needs? Please check all that apply.*

No AllergiesCeliac (you have been diagnosed as Celiac by a doctor and cannot have any cross-contamination with wheat products)Gluten-Free (you have a gluten intolerance)Dairy-Free (you have an allergy to milk products)Lactose-intolerant (you have an intolerance to lactose)Peanut AllergyTree Nut AllergyVegetarianVeganBee AllergyOther
Please explain the allergy and its severity:*
Do you carry an EpiPen for your allergy? (If yes, please note you must bring your own EpiPen in addition to the ones we carry in the first-aid kit.)*

YesNo
Due to the strenuous nature of the activities and remote environment, are there any physical, emotional, or mental health concerns we need to be aware of?*
Are there any special logistical needs, requirements, or prayer request for this experience? Your trip leaders pray for you by name before the expedition.*
On a scale of 1 to 10, rate yourself in health*
1- Health related issues are extremely challenging 10- No on-going health issues
On a scale of 1 to 10, rate yourself in physical strength*
1- A lot of difficulty lifting and carrying 30 lbs suitcase 10- Can easily lift and carry a 50 lbs suitcase
On a scale of 1 to 10, rate yourself in endurance*
1- Difficulty talking after walking up one flight of stairs 10- Able to jog 8+ miles
On a scale of 1 to 10, rate yourself in desire for spiritual growth*
1- Not interested in spiritual discussion or reflection 10- Extremely interested in spiritual growth
Would you like to clarify any of the ratings above?
Are you an international student?

YesNo
I have read the cancellation policy and agree to abide by that policy. I understand that I may be charged $50-$300 for canceling before the trip starts*

Yes
Should be Empty: