Program Year: *

Email *

First Name *

Phone *

Date of birth *

Would you consider yourself an Introvert, Extrovert, or somewhere in the middle? *

Introvert

Extrovert

Somewhere in the middle

What is your current level of physical activity? *

Minimal (perform less than one hour of aerobic exercise per week)

Moderate (perform some aerobic exercise, 1-3 hours per week)

Active (perform aerobic exercise 4 or more hours per week)

Could you see yourself wanting support with any of the following: *

Taking on more of a leadership role

Taking on less of a leadership role

Using your voice/taking up space during group activities

Stepping outside of your comfort zone

Backpacking *

No experience, but interested

Some previous experience

Considerable experience

Have instructed others

Rock Climbing *

No experience, but interested

Some previous experience

Considerable experience

Have instructed others

Mountaineering *

No experience, but interested

Some previous experience

Considerable experience

Have instructed others

First Aid *

No experience, but interested

Some previous experience

Considerable experience

Have instructed others

Orienteering/Navigation *

No experience, but interested

Some previous experience

Considerable experience

Have instructed others

Survival Skills *

No experience, but interested

Some previous experience

Considerable experience

Have instructed others