Rebel Challenge Course Reservation Request
Once you have completed this reservation request, your request will be reviewed and scheduled based on availability of dates and facilitators. The group contact person will then receive a confirmation email with additional details about your event. Cancellations must be made within seven days of the event date in order to avoid cancellation fees. If you cancel after this date, you will be charged $20 per facilitator. By clicking "accept" below, you acknowledge these terms and conditions.
Reservation Type
Group/Organization Name
Your answer
Group Contact Person(s)
Your answer
Cell Phone Number *lead facilitator will contact this number the day before the session
Your answer
Additional Phone Number(s)
Your answer
Email Address
Your answer
Requested Date of Session (please complete additional forms for multiple dates)
MM
/
DD
/
YYYY
Backup date
MM
/
DD
/
YYYY
Requested Start Time of Session
Time
:
Length of Session (see pricing chart on website for session description and cost)
Number of Participants
Your answer
Age Range of Participants
(click all that apply)
Required
Please describe any special needs or accommodations for any members of your group.
Your answer
How well do the group members know each other?
Your answer
What are your goals for this session?
Team Building, Trust Building, Communication, Problem Solving, Group Bonding, Challenge, Fun, etc.
Your answer
Are there any specific element(s) you would like to include in your session?
If so, what elements?
Your answer
Form of Payment
If paying by Departmental Transfer, please enter your account number and the name of the signatory officer:
Your answer
Submit
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