Sign Up Form for Green River Adventures: Kayak Instruction

Step 1: Call or E-mail for Date Availability.

Step 2: Fill out the Information Form below.

Step 3: A 50% non-refundable deposit is required to reserve your spot. This may be paid by credit card over the phone or by mailing us a check.

Inflatable Kayaking Trips may be reserved with a credit card that will not be charged until the day of your trip. We have a 24 hour cancellation policy for these trips.

**One form must be filled out for EACH partcipant**

**Inflatable Kayak Trip participants do not need to fill out this form**

* Required Fields

Contact information

* Trip Type
* Clinic Date
* Full Name
* Last Name
* Address
* City
* State
* Zip
* Home Phone
Office Phone
Cell Phone
* Email Address

Emergency Contact Info

* Full Name
* Who is this person?
* Address
* Home Phone
Office Phone
Cell Phone
Email Address

Medical Information

* Age
* Height
* Weight
Gender	Male Female
Do you have allergies to food, insects, or medications?	Yes No
Please list what you're allergic to:
How do you react to the allergen?
What medications do you take for this?
Do you have any medical or physical conditions that can affect you during physical exercise?	Yes No
What do you need to manage this condition?
Please list any medications you are currently taking:
Why do you take them?
* Please describe any serious injury, illness, or surgery you've had in the last five years?
* How often and in what activities do you regularly exercise?
* Please describe your swimming skills and comfort in mountain lakes and rivers:
* Please describe any paddling experience you have:
How did you hear about us?