Trip Type *
Full Name *
Home Phone *
Your Email *
Who is this person? *
Do you have allergies to food, insects, or medications?
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?
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?
89.7°FFeels like 89.7°FClear
4 Corners Whitewater :: 360 S. Camino del Rio #100 :: Durango, CO 81301 :: 970-259-4608 :: 888-723-8925
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