Uncommon Adventures
Participant Profile

Name: *

Address:    

Day Phone: *

Evening Phone:    

Email: *

Trip(s) you are registering for and the dates: *

1. How much backcountry tripping experience have you had?

Backpacking:  

Kayaking:  

Canoeing:  

2. Please rate your swimming ability.
None           Poor           Fair           Good           Triathlete          

3. Do you have a regular exercise routine? As in...?
 

4. Food questions…very important…we love to cook and we only use good body fuel on our trips. We can handle most any type of diet request with notice, but if there are hard to find items or adult beverages you are particularly enthused about you may want to bring them.

Are you a vegetarian? Yes           No

If so, what kind?

Please list any foods you will not eat:

Ah, now the good stuff.... what are your favorite foods?

5. What aspect of the trip interests you most? Birds, wildlife, fishing, gaining new back-country and paddling skills? We’ll try to stock a trip library to fit your interests.

6. Health Information (This is confidential, and important for us to help keep you safe.)

        Height  *              Weight  *              Age  *
        (This helps us fit your gear.)

        Allergies?
Yes           No

        Do you carry an Epi-pen? If so, please be sure it is current.
Yes           No        

        Severe asthma? If so, be sure your inhaler has plenty left.
Yes           No

        Heart condition?
Yes           No

        Orthopedic injuries or surgeries? (Hey, we wear out our hinges the more we play!)
Yes           No

        Regular meds?
Yes           No

        Had a recent physical?
Yes           No

        Phobias (baggage claim, Mondays, heights)?
Yes           No

        The box below is for your comments. If you answered "Yes" to any of the above questions,
        or if you have any other medical condition you would like to tell us about, please comment below.
   

        Health insurance company and policy number: Note: You should carry this information with you.
*

        Emergency contact person:
*

        Emergency contact phone number:
*

7. Arrival Information.

        Arrival Date:
   

        Are you....     Driving               Flying

        Airline and flight number (if flying):
   

        Pre-trip hotel (if not on our schedule):
   

        Hotel phone number or your cell number:
   

Additional comments or questions
   

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