Darwin Registration
This form is due with your final payment. This information helps keep you healthy, safe, and comfortable at Darwin! Please complete a separate form for each member of your group, including children. Thank you!
Background
Name
*
First Name
Last Name
Age (Height, Weight - if you would like to ride horses)
*
What is your arrival date at Darwin?
*
-
Month
-
Day
Year
Date
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Brief Medical History
Due to our remote location, we will be the first to help you in the case of a medical emergency. Oliver is our Wilderness EMT at the ranch. Help him keep you healthy and safe by sharing the following about your medical history.
Emergency Contact, if traveling alone or without spouse: (Name, Reliable Phone, Email, Relationship)
Have you had allergic reactions to any of the following?
*
Hay Fever
Bees / Wasps
Pet / Animal Dander
None
Other
If applicable, please provide further information for any of the allergies identified above, including food allergies. Please include what provokes and treats the allergy. Especially if you have experienced an anaphylactic reaction to the allergen.
Please list pertinent prescription medications you are taking or plan on taking while at Darwin.
Medication name, dosage, frequency, side effects (known and potential):
Do you have or have you ever had any of the following:
*
Altitude Sickness
Diabetes
Anxiety Reactions / Panic Attacks
Cardiac / Heart Problems
Epilepsy (Seizures)
Recurrent Dizziness / Faintness
Asthma, or other respiratory issues
None
Other
If you checked any of the conditions above, please explain as necessary. Please include any other health requirements.
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Dietary Restrictions
Are you vegetarian?
*
Yes
No
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Experience / Interest (for new guests only!)
Please list your experience and interest in the following activities:
Horseback Riding (information required to ride)
Fly Fishing
Hiking
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Arrival Information
Flight information, if applicable:
Shuttle information, if applicable:
Estimated arrival time at Darwin (after 10 AM please!)
*
Hour Minutes
AM
PM
AM/PM Option
Did you purchase Trip Insurance? (We strongly suggest you do!)
*
Yes
No
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Cleaning Preferences
We typically tidy your room daily, and change your towels mid-week.
Please let us know the level of housekeeping you prefer:
*
Daily
Mid-week
No thanks!
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Final question!
How did you hear about the Darwin?
*
Word of mouth
Previous Darwin guest (If so, let us know who in the "other" section so we can thank them!)
Google
Dude Rancher's Association
Travel and Leisure
JH Style Magazine
JH Traveller
Trip Advisor
Instagram
Wall Street Journal
New York Times
Other
Submit
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