Kananaskis Hiking Weekend Step 1 of 4 25% Personal DetailsName* First Last Pronoun* She/Her He/Him They/Them Birthdate* 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Continue to the next page to complete information on your fitness experience and medical details. How did you hear about this adventure? Facebook Instagram Twitter I have attended one of your other adventures and learnt about it while there A friend A friend who has been on one of your adventures RLAG website General web search Other Have you participated in any other Retreats or Expedition Events?* Yes No If so which ones?Fitness ExperiencePlease select level of fitness*BasicIntermediateAdvancedPlease describe your regular physical activities.*Example: I walk 5-8 km twice a week, do bootcamp 3 times per week etc.Medical InformationDietary requirements/restrictions.*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.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 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* Continue to the next page to select your dates and complete payment information.Dates & PaymentIn order to secure your spot for the Adventure Weekend, we ask that you select a date and submit a non-refundable deposit of $425.00 CAD per participant. Your deposit includes the processing fee of $12.00. If you are a Canadian Resident there is a 5% GST charge that will also be invoiced to you for your deposit and the invoices following. We only have 14 spots available in total per adventure retreat. Date Selection*October 2-3, 2021Trip Payment Policy*I agree to the trip payment policyThe trip deposit is CAD$100.00, your deposit is non refundable. After your initial deposit a follow up invoice will be send via paypal for the remaining CAD$180.00, this needs to be paid before the September 24, 2020. If you have not paid the second and final trip payment before September 24, 2020 then you are considered not coming and loose your spot on the trip. If you have to cancel your trip for any reason there are no refunds available. If you need to cancel your trip within 5 days of the trip date and have not paid the final trip payment you are responsible for paying the remaining amount owed for the trip. The total trip price is CAD$280.00 Please note that during our current COVID-19 Pandemic if there is any changes to our health care guidelines and we are unable to host our trip we will reschedule it and your deposit will be transferred to a new date. Personal Travel Insurance* I understand and agree to 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)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 above waiver Covid-19 Self Assessment Requirement* Difficulty breathing (e.g. struggling to breathe or speaking in single words) Chest pain Having a very hard time waking up Feeling confused Losing consciousness Mild to moderate shortness of breath Inability to lie down because of difficulty breathing Chronic health conditions that you are having difficulty managing because of difficulty breathing None of the above Please note that for the safety of everyone planning to attend our adventure we require you to complete a Covid-19 Self Assessment before attending. If you answer yes to any of the following questions please call 8-1-1 and we ask that you do not attend our adventure at this time. Are you experiencing any of the following or have you experienced any of the following symptoms in the last 14 days:Untitled* No Yes Are you experiencing cold, flu or COVID-19-like symptoms, even mild ones? Symptoms include: Fever*, chills, cough or worsening of chronic cough, shortness of breath, sore throat, runny nose, loss of sense of smell or taste, headache, fatigue, diarrhea, loss of appetite, nausea and vomiting, muscle aches. While less common, symptoms can also include: stuffy nose, conjunctivitis (pink eye), dizziness, confusion, abdominal pain, skin rashes or discoloration of fingers or toes. Fever: Average normal body temperature taken orally is about 37°CUntitled* No Yes Have you travelled to any countries outside Canada (including the United States) within the last 14 days?Untitled* No Yes Did you provide care or have close contact with a person with confirmed COVID-19? Note: This means you would have been contacted by your health authority’s public health team.Deposit CAD $100.00* Yes I understand This deposit is non-refundable deposit of CAD$100.00 This deposit secures your spot for the chosen adventure date. You will be emailed an invoice and detailed itinerary shortly. Your deposit is due upon receipt. The remaining amount is due before the adventure start date. Thank you so much. **Please note that during our current COVID-19 Pandemic if there is any changes to our health care guidelines and we are unable to host our trip we will reschedule it and your deposit will be transferred to a new date. I want to get news and updates from Run Like a Girl! Δ
