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Email Address *
Emergency Contact Name *
Emergency Contact Number *
16 – 20 21 – 30 31 – 40 41 – 50 51+
Prefer not to say Female Male
What race/ethnicity do you identify with? *
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino Other
How often do you day hike? *
Weekly Monthly Quarterly Annually Other
Average length of hike?
Have you been on a multi-day backpacking trip? *
If yes, how many from the last year?
Average number of days?
Where you guided or unguided?
What time do you prefer to hike? *
4 am – 10 am 10 am – 3 pm 3 pm – 6 pm After 6 pm
When do you prefer doing outdoor activities? *
Summer Winter Spring Fall All Year Long
What are you favorite outdoor activities?
How far are you willing to travel for a day hike?
Less than 1 Hour 1 – 2 Hours 2 – 3 Hours 3+
How many people do you prefer to hike with?
Alone 1 2 3+ Other
Other – Please specify
What are your main reasons for getting outside
To get exercise To reconnect with nature To connect with people To explore To mediate and relieve stress Other
In a typical week, how many times do you exercise?
What is exercise? Once a week, or less Two to three times per week More than three times per week
Tell me about the type of exercises you do?
Please rate your health and fitness level
I haven’t exercise in over a year Capable of walking 3 miles Very good, I’m capable of walking 3 miles with 1,000ft of elevation gain Kick Ass – I can bust out any 14er you give me
What is your preferred hiking level?
Easy (0-500 feet, 3-5 miles) Moderate (500-1000 feet, 6-8 miles) Strenuous (1000-1800 feet, 9-12 miles) Very Strenuous (over 1800 ft., over 10 miles) Other
Do you have any outdoor certifications/training?
What, if any, specific “themes” Interest you?
Difficulties faced when getting outside
Please check off the gear you need or don’t have