First name

Last name

Preferred name

Gender (optional)

Birthdate (MM/DD/YYYY)

Address (line 1)

Address (line 2)

City

State

Zip/Postal Code

Country

Home phone

Cell phone

E-mail address

T-shirt size

Guardian Information

Please provide information of a family member who could be reached in an emergency.

First name

Last name

Relationship to you

Home phone

Cell phone

Address (line 1)

Address (line 2)

City

State

Zip/Postal Code

Country

Background Information

Rank your interest to participate in the following trips (1 representing your first choice): (This will have no influence on whether you are randomly selected or not).

Boundary Waters Canoe Area (Canoeing or kayaking, some hiking)

Superior National Hiking Trail (All hiking)

**Your answers to these questions will in no way determine whether you are selected to the program or not. These will only be shared with your group leader upon your acceptance to the program. Please share honestly!

1. Why would you like to participate in the Macward Bound program?

2. What, if any, are your prior experiences in backpacking, canoeing and other outdoor experiences?

3. Please describe your level of physical activity.

4. Share 5 words that describe you.

Food restrictions/allergies/observances

Please indicate what, if any food arrangements you may need. We will do our best to accommate your needs.

Vegetarian
Vegan
Food allergy
Religious observance
Other need
Not applicable

In all cases except 'vegetarian' or 'not applicable', please provide specific details.

The fine print: I certify that I am physically and mentally able to participate in the above outdoor recreational initiatives. If selected for Macward Bound, I am responsible for paying a $350 program fee. I understand that participants will be selected at random via a lottery. If placed in the Macward Bound program I will make a payment of $350.00 no later than July 26, 2013. I understand if placed in a Macward Bound program my payment is non-refundable.

Initials