Walking In The Woods registration form

Walking in the Woods

Registration Form
Please enter start date of trip

MonthDayYear
Date
Please indicate which trip your choosing
Personal Details
Full Name*

First NameLast Name
If Under 18 Name of parent or gaurdian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
E-mail*
Phone Number*

Area CodePhone Number
Emergency Contact Information

This should be someone who is not on the trip with you.
In order of priority
Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Health and Fitness
We take your safety very seriosly. For this reason we require your relevant physical and medical information to insure both your safety and enjoyment of your trip. Please read each section carefully and answer as thoroughly as necassary.
Height*
Weight*
Date of last Medical Check Up*

MonthDayYear
Health status at time of last medical Check Up*
How would you describe your current fitness/activity level?*
If you have had a serious illness or conditions requiring hospitalization in the past five years or currently have any physical limitations, please explain below. Enter N/A if not applicable.*
Please list any allergies and medications used to manage them. Enter N/A if not applicable.*
Alllergy management medications must be in original containers/packaging, within displayed expiration dates, and with participant at all times.
Please list any medications taken on a regular basis (do not include medications already listed in allergy section above) and what the medications are for. Enter N/A if not applicable*
Medications must be in original containers/packaging, within displayed expiration dates, and with participant at all times.
Food Preferences
These are sensitivities or preferences (i.e. vegetarian). Allergies should be listed in the allergy section above. Enter N/A if not applicable*
Thank you for completing the Registration Form. If you are completing the Registraion Form without a payment click the Submit button below. If you are paying with Pay Pal, Credit/Debit Card indicate the trip you you are purchasing, the number of participants you are paying for and click the appropriate link below.
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Backpacking 101 Deposit$100.00

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Guided Trip$240.00

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Walking in the Woods

Personal Details

Emergency Contact Information

Health and Fitness

Food Preferences