BOULDERFEST WAITING LIST REGISTRATION

I'm sorry to say that Bouderfest Registration is full.
But fill this out to get on the waiting list.



Contact Information:
Contact Name:
Phone Number:
Fax Number:
Email Address:
Mailing Address:
Town/City:
Province:
Postal Code:

I would like to register for:
(Please choose a departure time and return time from the options.)
Departure
Date
Time
FULL June 19 8:00 am
FULL June 19 8:30 am
FULL June 19 9:00 am
FULL June 19 9:30 am
FULL June 19 10:00 am
FULL June 19 10:30 am
FULL June 19 11:00 am
FULL June 19 11:30 am


Return
Date
Time
FULL June 20 12:00 pm
FULL June 20 12:30 pm
FULL June 20 1:00 pm
FULL June 20, 1:30 pm
FULL June 20 2:00 pm
FULL June 20 2:30 pm
FULL June 20 3:00 pm
FULL June 20 3:30 pm




Confidential Medical Information:
Date of Birth: Sex:
I have difficulty with: Vision Hearing
Are you in good physical health? YES If NO, describe:
Describe:
Are you currently taking any medications? NO If YES, describe:
Describe:
Do you have any dietary considerations the facility/leaders should know about? NO If YES, describe:
Describe:
Do you have any limiting forms of heart condition? NO If YES, describe:
Describe:
In Case of Emergency Contact
Contact Name:
Work Phone Number:
Home Phone Number:
Relationship to you:

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