Trailblazers Adventures Registration Form

Thank you for your interest in our Trailblazers Adventures Club! We know there are quite a few questions, but each one is important. Please reach out if you need any help. For the best experience, we recommend completing this form on a computer. If you prefer a printed version or a pdf version, we’d be happy to provide one.
Today's Date*

MonthDayYear
Date
Which adventure(s) do you want to sign up for?*

July 17 - Mini-Putt (Evening)August 5 - Movie Adventure Day (Full Day)August 6 - Binbrook Con. Area (Full Day)August 13 - Mini-Putt (Evening)August 19 - Movie Adventure Day (Full Day)August 21 - Geocaching (Evening)August 25 - Guess Where Trip
Trailblazer Information
Full Name*
Date of Birth*

MonthDayYear
Date
Are you already a registered Trailblazer member?*
If you have completed a registration form for: 1:1 Services, The Trailblazers Club or The Trailblazer Travel Club already, please select 'YES'.
Phone Number*
Address*
Trailblazer's Email Address (if primary contact)
We primarily communicate via email, unless otherwise specified or in the case of an emergency.
Primary Contact

This is the person (if different from above) we will contact for program updates, scheduling changes, and important information. If Trailblazer is the primary contact, please skip this part!
Contact Name
Contact Phone Number
Contact Email Address
We primarily communicate via email, unless otherwise specified or in the case of an emergency.
Relationship to Trailblazer
Medical
Has your medical situation or medical protocols changed?
Please list any medical conditions, allergies or dietary restrictions that we should be aware of. If there are any safety-related medical considerations (e.g., seizure protocols), please include them here.*
Do you carry an Epipen?*
Accommodations & Supports
Has your accommodations/supports or behaviour plan changed?
What accommodations or supports can we provide to help you participate comfortably?*
Group Outing Suitability Confirmation*

I confirm that the Trailblazer registered is able to participate in a group setting supported at a 1:3 ratio, does not require significant behavioural redirection, and is comfortable with full-day outings. I understand that these trips are designed for folks who are fairly independent and enjoy being out and about for extended periods. I confirm that the Trailblazer has been included in the decision to register for this outing.
Funding
Where should invoices be sent?

Directly to me (Trailblazer or Primary Contact)To my Passport One funding contact (provide details)Other (please specify)
📩 If Passport One or Other, please provide the contact name & email:
I consent to Unique Optimism contacting my Passport One worker or other funding contacts.
Refund Policy

By submitting this form, I agree to the following:
Cancellation Policy Acknowledgement:

I understand that full payment is required within 24 hours of receiving the invoice, to secure a spot for the adventure. *Please do not send this until your spot is confirmed and you receive an invoice*

I acknowledge cancellations made more than 14 days before the adventure will receive a full refund minus a $10 admin fee.

I acknowledge that cancellations made within 14 days of the adventure are non-refundable under no circumstances. No exceptions will be made.

If the adventure is cancelled by Unique Optimism, a partial refund will be issued, minus any prepaid costs and a $10 admin fee.
I have read and agree to the Cancellation and Booking policy.
Consents & Permissions

(Please review and consent to the following sections)
Informed Consent Statement*

I understand and consent to the collection and use of the information provided in this intake form for support purposes, and acknowledge the confidentiality policies as described.
Confidentiality Agreement*

I understand that all personal information collected will be kept confidential and shared only with authorized personnel as required by law.
Health and Safety Consent: In case of a medical emergency, I consent to the necessary medical treatment for my Trailblazer, including transportation to the hospital if required. Please note that all efforts will be made to contact the emergency contact provided.*

YesNo
Photo & Video Consent*

Yes, I consent to being photographed or filmed during my participation in activities for promotional and documentation purposes by Unique Optimism, including use on social media, websites, or other digital and printed materials.I do not consent to being photographed or filmed for promotional or documentation purposes.
Publicity Consent*

Yes, I consent to my image, video, or personal story being used in media for publicity or promotional purposes (e.g., news outlets, press releases, interviews, ads, or other public-facing materials).No, I do not consent to my image, video, or story being used in media for publicity or promotional purposes.
Email Communication Consent*

Yes, I consent to receiving emails related to support, programs, updates, newsletters, or promotional materials from Unique Optimism.No, I do not consent to receiving emails.
Liability Waiver & Consent
I, the undersigned, as the primary contact/legal guardian, acknowledge the potential risks involved in participating in this program. I give my consent for the Trailblazer to take part in the activities outlined, and I agree to release Unique Optimism, its staff, volunteers, and affiliates from any liability for injury, loss, or damage resulting from participation in these activities.
Primary Contact Signature*
Date*

MonthDayYear
Date
Thank you for filling out this form!

I appreciate you taking the time to register. Once I receive your form, I’ll review it and reach out to you directly. If there is a spot available for the adventure that you selected, you’ll receive a welcome email and an invoice for the full amount to secure your spot (due within 24 hours of receving the invoice). Please do not send your payment until you hear back from me. If the adventure is already booked, I'll let you know and can add you to the waitlist for that session or offer spots on other advntures.

Feel free to reach out if you have any questions. I look forward to having you join us for an adventure!
Should be Empty:

Trailblazer Information

Primary Contact

Medical

Accommodations & Supports

Funding

Refund Policy

Consents & Permissions

Liability Waiver & Consent