Shoestring Adventures Enrollment Form
Please take a few moments to provide your information below. Your responses are strictly confidential and will be used by Shoestring Adventures staff to support your health and safety. Please feel free to contact us at info@shoestringadventures.com with any questions or concerns.
Email address *
What trip are you going on? *
How did you hear about this trip? *
Personal Information
Last Name *
Your answer
First Name *
Your answer
Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Birthday *
MM
/
DD
/
YYYY
Emergency Contact Information
Please select someone who is not on the trip with you.
Emergency Contact *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Health Form
In the interest of the personal safety of both the participant and the other participants, please consider the questions carefully when completing the health form. A "Yes" answer does not automatically prohibit a participant's enrollment. If we have any question about the participant's capacity to successfully complete the trip, we will follow-up the participant to discuss it.
Do you have any preexisting medical conditions or injuries that we should know about? *
If none, write "none."
Your answer
Any history of: *
Yes
No
Heart Disease
Heart Attack
Stroke
High Blood Pressure
Lung Problems? COPD? Asthma?
If "yes," do you carry an inhaler?
Diabetes
If "yes," do you use insulin?
Are you on any medications? *
Please list them all, frequency, and what they are for. Also, please tell us what happens if you don't take them.
Your answer
Do you have any medication allergies? If so, please list them and your reaction. *
If none, write "none."
Your answer
Do you have any environmental allergies? If yes, please describe your reaction and how you treat it. *
If none, write "none."
Your answer
Have you ever used or been prescribed an epinephrine auto injector (EpiPen)? *
Are there any foods you can't eat? *
Please tell us if there are any foods that cause anaphylactic shock, major allergic reactions, bad GI issues, etc. and what happens if you ingest it? Can you be near it? Tell us all of it... If none, write "none."
Your answer
What style of eating do you identify with? *
Heath Insurance Carrier
(If applicable)
Your answer
Health Insurance Policy Number
Your answer
Gear
Do you need to borrow any gear from Shoestring Adventures? *
In an effort to make the outdoors more accessible to first-time Warriors, the following gear is now available to borrow for no additional charge; however, if you have your own gear, we encourage you to use it! If you borrow a sleeping bag, you will need to bring your own liner.
Required
Experience
How would you describe your level of hiking experience? *
How would you describe your level of backpacking/camping experience? *
Briefly describe your plan to prepare for your upcoming trip. *
Your answer
Do you have any first aid/CPR training? *
Not required, just good to know.
Your answer
Logistics
Passengers should contribute to their driver for gas and wear and tear.
Where will you be coming from? *
City, State, Airport (if applicable)
Your answer
Are you interested in carpooling with other members to the event? *
If you are willing to drive, how many passengers can you comfortably take with gear?
If you're flying in and have your flight info, please include it here.
Flight number, airline
Your answer
Arrival Date/Time
MM
/
DD
/
YYYY
Time
:
Departure Date/Time
MM
/
DD
/
YYYY
Time
:
Introduce Yourself
Your bio, links and photo will be included in the Welcome Kit, which includes introductions to your guides and fellow campers.
Website
Your answer
Instagram
Your answer
Twitter
Your answer
Write a 1-sentence bio about yourself. *
Your answer
Email us a selfie!
After you submit your answers, please email a photo of yourself to alyx@shoestringadventures.com, so we can introduce you to the group! Please do not navigate away from this page before you click submit, or you may lose your answers!
A copy of your responses will be emailed to the address you provided.
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