7 Day White Water Rafting on the San Juan

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We are excited you’ll be joining us on this incredible expedition! 

We require detailed information in the following registration form to safely and effectively execute our programs. 

*Please set aside adequate, uninterrupted time to complete this registration*
(Average completion time 20 minutes)

Before you begin:

  • Please complete this registration form on a computer, not on your phone.
  • Please have your health insurance card and information available

 

Fill out the information below, then click Next to proceed.

INVITEE INFORMATION










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Registration Questions






Health Questions

No Barriers USA requires all participants to complete this medical assessment. Please help us optimize the medical review process.

1.) Be Honest. NBUSA wants you to participate and we strive to accommodate most medical conditions. It is in everyone's best interest to disclose medical information upfront. 

2.) Be Thorough. Fill out the medical fields and forms completely. Incomplete or blank answers will require NBUSA to contact you and may delay your acceptance to the program.

3.) Communicate Changes. If there are any new medical conditions or changes in medical status or medications before your program starts, update them here and contact NBUSA immediately at 970-484-3633. Unreported changes may result in dismissal.

4.) Be Timely. Be sure you complete this online assessment by your group's deadline and have your Health Care Provider review your submission and sign Health Care Provider form. NBUSA will review this health assessment, as well as the separate Health Care Provider Form, and contact you if questions arise.
General information




Medical History:

Yes No

Yes No



Medications: Participants must bring AN EXTRA supply of any prescription medications that they will need to take. Participants who have had an anaphylaxis reaction must provide their own epi-pens. 

Yes No



Altitude Sickness: When traveling above 8,000 feet, does the participant have a history of:
Yes No Unsure
Sickle Cell: Has the participant or participant’s parent(s)/sibling(s) tested positive for:
Yes No Unsure
Substance Use: Does the participant:
Yes No

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Insurance Information






No Barriers USA requires that a licensed medical professional (Medical Doctors, Doctors of Osteopathy, Licensed Nurse Practitioners and Physician Assistants are all acceptable) review your above responses. 

DIRECTIONS:  
1. Please download and print the Health Care Provider Form (link below).  
2. Print the answers to the medical questions you submitted here (which will be emailed to you with your confirmation). 
3. Bring the printed versions of the Health Care Provider Form and your responses to your appointment with your medical professional.  
4. Have your medical professional review and evaluate your health status and sign the Health Care Provider form.  
5. E-mail electronic copies of the signed Health Care Provider Form and the Minor Consent to Travel Form (links below) to Brian.Eimstad@nobarriersusa.org (Expeditions Coordinator)
Health Care Provider and Additional Forms:


Adult Medical Release Waiver 





Booking Terms and Conditions







Student Risk and Release Agreement






Adult Risk and Release Agreement


Payment

Total trip cost (without trip insurance): $2,295

Payment summary/schedule:
  1. Mandatory Deposit: $200, due upon completion of this registration as outlined in the booking conditions
  2. (Optional Trip Cancellation Insurance: $99, due upon completion of registration if selected-- see below)
  3. Remaining $2,095 after $200 deposit, to be paid in three equal monthly payments of $698 automatically charged to the card provided below on the 1st of each month, May 2019 - July 2019 



If you choose not to purchase trip cancellation insurance during registration, you can purchase it up to 75 days before the departure of the trip by sending (or dropping off) a check made out to "No Barriers USA" for $109 with the memo "trip cancellation insurance." Our address is 224 Canyon Avenue, Suite 207, Fort Collins, CO 80521.
Payment Information






Billing Address