Outdoor Adventure Pre-Conference Trip Application
Cultivating Awareness and Developing Skills: Experiential Learning in the Rocky Mountains
Full Name: *
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Address: *
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Phone Number: *
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Sex: *
Email: *
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Emergency Contact Name: *
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Emergency Contact Phone Number: *
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What (if any) previous outdoor adventure experience do you have? *
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I have completed "The Physical Activity Readiness Questionnaire" found at http://eparmed-x.appspot.com/?locale=en#pub/parq *
Although the planned physical activities will not be considered highly strenuous, they would be considered low to moderately strenuous, especially for those who have not experienced mountain hiking. As such, a fitness readiness assessment will need to be completed by each participant: one should be able to walk a distance of 3.2 km on flat ground with 15 lbs in their backpack in under 30 minutes. Have you successfully completed this fitness assessment? *
Please list any physical or medical limitations that might affect your participation on this trip: *
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Please list any allergies you may have:
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Please list any dietary restrictions or preferences:
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Do you have a particular person you would like to share a tent with? If so, include their name below:
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I understand that the total cost will be approximately $163/person *
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I understand that I will be responsible to bring the gear and equipment listed on the gear list (and will rent if necessary). *
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Anything else we should know to make your trip more safe or enjoyable?
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RELEASE/WAIVER *
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Please let us know if you anticipate needing overnight accommodations and/or an airport transfer on Thursday/Friday. Airport transfer fee and flight information is addressed on the CACSD conference registration form.
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Please make cheque payable to Ambrose University and send it to:
150 Ambrose Circle SW
Calgary, AB T3H 0L5
Canada

Attention: Wally Rude

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