challenge-course-reservation-request

Group Information

Group Name*

What you would like your group to be called

Number of Participants*

Minimum of 10

Age of Youngest Participant*

Age of Oldest Participant*

Requested Date*

Requested Arrival Time*

Requested Departure Time*

Course Request*

Outdoor Indoor Portable

Main Contact*

Primary Phone*

Phone Number Day of*

Phone number to call on the day of the event

Primary Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Assessing your needs

Please fill out the information below to the best of your knowledge because while you are here we want to be able to best serve the needs of your group. Please be specific when filling out this form.

Group's purpose/type of organization*

How long the group has been together and group dynamics*

Groups strengths/weaknesses*

Goals you would like to see your group accomplish*

Are there any special needs of individuals or the group that the facilitators should be aware of?*

Yes No

Please provide details about these needs*

Are there any special requests?*

Yes No

Please provide details about these requests*

How does your group plan to follow up on this experience?*

Any additional pertinent information*