Step 1 of 5 20% Name* First Last Pronoun* She/Her He/Him They/Them Personal DetailsBirthdate* MM slash DD slash YYYY Email* Enter Email Confirm Email Phone number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRĂ©unionSaint BarthĂ©lemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land Islands Country Continue to the next page to complete information on your fitness experience and medical details.How did you hear about this trip?* Facebook Instagram Twitter I have attended one of your other adventures and learnt about it while there A friend A friend who has attended an RLAG Adventure RLAG website General web search Other General Fitness Level*BasicIntermediateAdvancedPlease describe your regular physical activities.*Example: I walk 5-8 km twice a week, do bootcamp 3 times per week etc.By checking the box below you acknowledge that this trip requires hiking experience.* I agree and understand I do not agree If your hiking and fitness base is less then basic or you are unsure please email courtney@runlikeagirl.ca and we can talk about it. Medical InformationDietary Restrictions:*Medications.*Please list all medications (prescribed and non-prescribed) you are taking, if any. Include dosage/frequency and condition being treated. If you aren't taking medications, please state that in this field.Do you have any pre-existing medical conditions or physical limitations that could affect your ability to fully participate in this active, adventure travel trip?*Include ALL medical conditions, disabilities, past surgeries (especially related to hip/knee replacements, joint injuries, cardiac, etc.), mental health issues and any other health concerns you think could be relevant to your participation in this trip.Do you have any known Allergies?* Yes No If so, please list allergens, signs of reaction and describe the severity of your allergies.*Are you required to carry an epi-pen?* Yes No Do you feel you have any psychological limitations?*EG: Fear of water, fear of heights, anxiety etc.Please tell us about your experience as a traveller and adventure lover.* Emergency Contact Name* First Last Emergency Contact Relationship* Emergency Contact Phone Number* Emergency Contact Email* Dates & PaymentDate Selection*January 22-23, 2022Trip Payment Policy*I agree to the payment policyOnce your registration form is submitted, an invoice for your trip deposit and remaining amount will be emailed to you. (This may take a few days to receive.) The full balance needs to be paid before January 15, 2022. The deposit of CAD$100.00 is due upon receiving the invoice. If you have not paid the balance before the trip start date then you are considered not coming and loose your spot on the trip. There are no refunds for any flight, activities, transportation or accommodations that have been booked and are holding your spot. If you have to cancel your trip for any reason there are no deposit refunds available. All permits booked are non refundable and non transferable as they are sold on an individual basis to your passport number. Total Trip Cost: CAD$399.00 Deposit: CAD$100.00Personal Travel Insurance* I understand and agree that I have personal travel insurance for this trip Travel Insurance Run Like A Girl Adventures Inc requires travel insurance for all of our trip participants and we are partnered with World Nomads Travel Insurance. Travel insurance for independent travelers and intrepid families. You’d rather not think about all of the things that might go wrong on your trip, but these things can and do happen. Please check the box below to confirm that you will have travel insurance for this trip. Purchase Travel Insurance (Link opens in a new tab)Covid19 Vaccinations I understand, I am fully vaccinated. I understand that I need to be fully vaccinated to participate on this adventure. I also understand, in addition, that I may be required to show proof of vaccination going into restaurants and shops in town. I am also required to have a face mask with me at all times. Waiver Please click here to read our waiver and check the box below to agree. This is mandatory! (Link opens in a new tab)* I have read and agree to the waiver I want to get news and updates from Run Like a Girl! Δ