REGISTRATION FORM

MOUNT EPIC SUMMER TRIP

Name

First Name

Last Name

Email

Phone

(###)

###

####

Why are you choosing to join Mount Epic?

What is your experience with wilderness living and backpacking?

Please provide relevant health information here

Ie. medical concerns, allergies/sensitivities, behaviour, medications, speech or language, vision/hearing impairments

Do you have any fears or apprehensions about the trip?

Is there anything else you would like us to know?

How did you hear about us?

Parent/Guardian 1 Contact Info

First Name

Last Name

Email

Parent/Guardian 2 Contact Info

First Name

Last Name

Email

July 10th - 23rd

Please fill out the form below. Once we receive it, we will send you more information about payment and the trip