Your Fitness Level:
Relation to Applicant:
Emergency Contact Phone Number:
Arrival Date & Time
Airline & Flight Number
Departure Date & Time
Do you require a pick-up from Canyonlands Field Airport?
We recommend that you consult your physician regarding your participation in one of our retreats. Please contact us if you have ANY questions regarding your ability to participate.
What is your present state of health?
Do you have any pre-existing medical conditions?
Do you currently take any medications and if so, which ones?
Do you have any pre-existing injuries we should be aware of?
Are you pregnant and if so, how many months?
Do you have any allergies?
Do you require Vegetarian fare?
Do you have any dietary restrictions?
Please share what food you prefer to not eat:
Please note that each of our retreats vary in difficulty (see descriptions). What kind of physical condition would you say you are in? Include activities in which you participate in and the frequency of each activity.
How long have you been practicing yoga?
How many times a week do you practice yoga?
Do you have a meditation practice?
Do you have a pranayama (breath work) practice?
What most interests you about our retreats?
What would you like to get out of this experience?
Do you have any experience hiking at elevations above 5,000 ft? If so, when and where? (No experience is required).
*For Base Camp / Backpack Retreats Only*
What fuel type do you use for your stove?
Do you have any experience rock climbing? Please explain. (No experience is required)
Do you have any concerns or apprehensions about our retreats?
How did you learn about us?
Are you afraid of heights? If so, please explain to what extent.
Some, but not all, of the unforeseeable risks you may be exposed to include flash flood, rain, snow, lightning, extreme weather changes, winds, high temperatures, wild animals, venomous reptiles, insects, obscure hazards, downed trees, steep slopes, and terrain lacking water sources.
These and other risks and hazards can result in injury, damage, permanent disability, death, or loss.
All participants should wear proper clothing and footwear and carry water for the duration of the outdoor activity, recognizing the responsibility they have to be prepared for a variety of conditions and terrain.
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