Please fill out Application Form below and click the submit button. Once we RECEIVE your application we will review it, and provide a follow up email to verify your acceptance. Thanks!

Name

First Name

Last Name

Which trip are you hoping to attend?

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Select

Gender:

Height / Weight:

Health Restrictions:

Dietary Restrictions:

Activity Restrictions:

Emergency Contact Person:

Name / Relationship to you / Phone

Waiver:

In case of a medical emergency, I hereby give my permission to the physician selected by ULTIMATE WILDERNESS ADVENTURES director, to hospitalize, secure proper treatment for, and to order injections, anesthesia, or surgery for myself/ child as named on the registration hereof. I / we do hereby release ULTIMATE WILDERNESS ADVENTURES’ agents, employees, interns, and volunteers from any liability whatsoever arising out of injury, damage or loss which may be sustained his/her involvement during their Adventure.

By checking box below I verify all infromation provided is accurate and consent to all terms in this application.

I consent.

Please fill out Application Form below and click the submit button. Once we RECEIVE your application we will review it, and provide a follow up email to verify your acceptance. Thanks!

Plan your next adventure . . .