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Good news! You have already completed and signed the medical record for this application. This online form cannot be submitted a second time. If you need to update the medical information for this application, please contact your Course Advisor. 
Let's get started with your application!  You will need about 20-30 minutes to complete and can save your progress and finish at a later time.

Information will be kept confidential and will be used for the evaluation of your health and readiness to participate on your Outward Bound course.  






















Participant Information


First, we'll collect some information about the participant.




Jr, Sr, III, etc.



MM/DD/YYYY

Invalid Age





Understanding an applicant's pronouns helps our staff provide the best support, both in preparation for course and on course. Options are included for applicants who do not identify exclusively as male or female.


Understanding an applicant's gender identity helps our staff provide the best support, both in preparation for course and on course.























Please do not enter a parent email


Please do not enter a parent phone number

Providing a mobile phone enables you to opt in to receive text message notifications regarding the status of your Outward Bound application.

Opportunities to receive text message notifications regarding the status of your Outward Bound application may vary by course and location. 


 Essential Eligibility Criteria

Colorado Outward Bound School (COBS) courses range from one-day teambuilding programs to 81-day semester courses with the mission of changing lives through challenge and discovery.  The physical and mental health and safety of our students and staff are a top priority along with the educational quality of the course experience for all participants.   COBS values inclusion, equity, and diversity and strives to provide a positive learning environment for all participants but does not specialize in experiences for people with disabilities or significant mental, emotional, or behavioral conditions.  COBS instructors are not therapists and are not trained in adaptive programming, nor are they able to provide specialized individual support for these conditions. The Essential Eligibility Criteria are applied to all participants on all COBS courses.  The Essential Eligibility Criteria is a list of the minimum essential criteria that a participant must possess for each activity to be eligible for a COBS course, not an all-inclusive summary of what may happen on your course.  If an applicant does not meet specific criteria, COBS might be able to assist an applicant if it does not significantly alter the fundamental nature of the course activity, jeopardize the health and safety of COBS students or staff, or place an undue administrative or financial burden on COBS.   

ONCE ON COURSE, INABILITY TO MEET THESE ESSENTIAL ELIGIBILITY CRITERIA MAY RESULT IN REMOVAL FROM COURSE WITHOUT REFUND.
COBS General
These criteria apply to all COBS programs. It is essential that each participant must:
  • Be able to recognize safety hazards and effectively communicate with staff in a timely manner regarding impending danger, personal physical, medical, and/or mental health distress, or, if requiring additional support.  Participants must be able to warn others in limited visibility, and/or with loud background noise such as thunderstorms or whitewater rapids.
  • Be able to understand and reliably follow verbal and visual safety instructions whether supervised or not.  Hazards students may receive instruction about and may need to be able to visually identify include, but are not limited to hot/cold temperatures, darkness, sunburn, lightning, cliff edges, rugged and uneven terrain, potentially hazardous animals and insects.
  • Be able to refrain from self-injurious behaviors, violence, threats and aggressive or intimidating outbursts.
  • Be able to perform essential self-care, including maintaining adequate nutrition and hydration, dressing appropriately for environmental conditions, maintaining personal hygiene, and managing known medical conditions.
  • Be able to refrain from using alcohol, smoking, and all unapproved substances, and misuse of prescription or non-prescription drugs.
  • Be able to be respectful of the various identities (such as race, ethnicity, sex, gender, sexual orientation, religion, ability, and nationality) of others; refrain from behavior that is discriminatory to other’s identities, socially exclusive behavior, and language that is derogatory or harmful to others.
  • Be able to contribute to a safe, inclusive social and learning environment; maintain appropriate relationships with other group members and instructors; and refrain from behavior that disrupts the learning of others.
  • Be symptom-free of communicable diseases for 72 hours prior to course start and arrive at course start symptom-free of communicable diseases.  Arriving with symptoms of communicable diseases may result in isolation or non-admittance to course transportation.
Wilderness-based
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, and must:
  • Be able to lift at least 35% of their body weight, or 40 lbs. (18 kg) (whichever is less). 
  • Be able to travel and camp during periods of inclement weather and/or at night-time in a remote backcountry environment for the length of course.  Course sites may require one or more days of travel to reach the nearest road or advanced medical care.
  • Be able to manipulate small objects (fine motor skills) to accomplish functions (ex. knots, carabiners, zippers, buckles, etc.)
  • Be able to adapt to the physical, emotional, and social demands of an expedition—traveling each day, sleeping on the ground, living and working 24/7 with others; and able to be flexible in ways of living. 
THE FOLLOWING ARE ADDITIONAL ESSENTIAL CRITERIA SPECIFIC TO COBS COURSE ACTIVITIES:
Alpine Backpacking or Mountaineering
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, Wilderness-based Essential Eligibility Criteria, and must:
  • Be able to ascend, descend, or traverse rugged, uneven, and steep (ex. 30-50°) terrain (on and off-trail) covered in snow, water, loose rocks, or thick vegetation at elevations of 12,000 ft (3650 m) for five miles or more over consecutive days while wearing a backpack weighing at least:
    • Alpine Backpacking: 35% of their body weight of 40 lbs. (18 kg) (whichever is less)
    • Mountaineering: 45% of their body weight or 50 lbs. (22 kg) (whichever is less)
  • Be able to wade across cold rivers or streams lacking bridges with the assistance of others.
  • Be able to maintain composure and follow instructions in environments with heights and exposure.
  • Be able to wear a helmet to manufacturer specifications.  [Our helmets fit head-sizes from 18.9-24.4” (48-62 cm)].
  • MOUNTAINEERING ONLY: Be able to use at least three points of bodily contact to climb or descend obstacles.
  • MOUNTAINEERING ONLY: Be able to fit and wear a harness to manufacturer specifications.  [Our mountaineering harnesses fit waist-sizes from 23-43” (58-110 cm)]. 
Canyon Backpacking or Canyoneering
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, Wilderness-based Essential Eligibility Criteria, and must:
  • Be able to ascend, descend, or traverse rugged, uneven, and steep (ex. 30-50°) terrain (on and off-trail) covered in slickrock, water, loose rocks, or thick vegetation at elevations up to 7000 ft. (1800 m) for four miles or more over consecutive days while wearing a backpack weighing at least:
    • Canyon Backpacking: 35% of their body weight, or 40 lbs. (18 kg) (whichever is less)
    • Canyoneering: 40% of their body weight or 45 lbs. (20 kg) (whichever is less)
  • Be able to wear a helmet to manufacturer specifications. [Our helmets fit head-sizes from 18.9-24.4” (48-62 cm)].
  • Be able to travel through moving or stationary water with assistance.
  • Be able to maintain composure and follow instructions while in dark, tight, or enclosed quarters in a slot canyon.
  • Be able to use at least three points of bodily contact to climb or descend obstacles.  
Climbing
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, Wilderness-based Essential Eligibility Criteria, and must:
  • Be able to use at least three points of contact to climb or descend obstacles.
  • Be able to wear a helmet to manufacturer specifications.  [Our helmets fit head-sizes from 18.9-24.4” (48-62 cm)].
  • Be able to fit and wear a harness to manufacturer specifications.  [Our climbing harnesses fit waist-sizes from 23-43” (58-110 cm)]. 
  • Be able to maintain composure and follow instructions in environments with heights and exposure. 
Ropes Course
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, Wilderness-based Essential Eligibility Criteria, and must:
  • Be able to wear a helmet to manufacturer specifications.  [Our helmets fit head-sizes from 18.9-24.4” (48-62 cm)].
  • Be able to fit and wear a harness to manufacturer specifications.  [Our full-body harnesses fit waist-sizes from 18-55” (45-140 cm)].
  • Be able to maintain composure to follow safety instructions at heights of up to 40 ft (12 m).
  • Be able to manipulate safety devices above head level.
  • Weigh less than 270 pounds to be able to ascend to element height.  Other participants can still assist and participate from the ground level.  
Water-based (Rafting, Canoeing, or Kayaking)
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, Wilderness-based Essential Eligibility Criteria, and must:
  • Be able to wear a Personal Flotation Device (a.k.a. lifejacket) according to manufacturer specifications.  [Our Personal Flotation Devices fit chest-sizes from 24-58” (61-147 cm) and a minimum of 50 lbs (22 kg)].
  • Be able to wear a helmet to manufacturer specifications.  [Our river helmets fit head-sizes from 20.9-24.4” (5362 cm)].
  • Be able to remain seated and balanced while holding a paddle with two arms.
  • Be able to control a paddle and move it through the water to steer and propel a boat forward in or out of current for up to 8 hours for consecutive days.
  • Be able to maintain composure to follow instructions while in cold or turbulent water.
  • Be able to orient self in the water while wearing a Personal Flotation Device to face downstream with head and feet above the water.
  • Be able to actively make 20 ft (6 m) of progress while immersed in water and wearing a Personal Flotation Device.
  • Be able to ascend, descend, or traverse rugged, uneven, and steep terrain (on and off-trail) covered in slickrock, wet surfaces, loose rocks, and/or thick vegetation. 
Winter (Nordic skiing, Snowshoeing, Ski/Snowboard)
It is essential that each participant must meet the COBS General Essential Eligibility Criteria, Wilderness-based Essential Eligibility Criteria, and must:
  • Be able to independently ascend, descend, or traverse rugged, uneven, and steep terrain (on and off-trail) covered in snow, ice, loose rocks, or thick vegetation at elevations of 11,000’ (3350 m) or more while moving gear weighing at least 50 lbs. (22 kg) or 45% of their body weight (whichever is less) over consecutive days using a sled, backpack, or a combination of the two.
  • Be able to shovel snow for periods of at least 15 minutes.
  • Be able to maintain composure, dress for the environment, and manage nutrition, hydration, hygiene at 0° F/18° C or colder for consecutive days.
  • Be able to learn and independently perceive and differentiate visual signals from an avalanche transceiver.
  • DOWNHILL SKIING/SNOWBOARDING COURSES ONLY: Be able to descend slopes with a blue square rating at ski resorts with comfort and control. 

Veterans Course Details


Outward Bound Veterans courses are open to active duty servicemembers and veterans of all conflicts who have deployed or have been stationed overseas as a part of their service.


Grieving Teens Course



This is important for us to know prior to interviewing the applicant.

MM/DD/YYYY



Sliding Tuition Scale


To advance our equity and inclusion efforts and remove barriers to access, this course has a sliding-scale tuition model. If paying the full tuition is not within your means, we have the funding to support you. If you can pay full or a portion of the tuition, we appreciate you doing so. As a nonprofit organization, the tuition we receive helps us support more students on course. Please take the time to reflect on what amount of tuition is accessible for you. 

It may be helpful to ask yourself the following questions*:
  • Are you and your family homeowners or landowners?
  • Have you attended private education, or have an advanced degree?
  • Does your organization cover your professional development expenses?
  • Are your bills or credit cards on autopay?
  • Can you easily access and afford healthcare services?
  • If you are a caregiver, can you easily access and afford care services for your caregiving responsibilities?
  • Do you have little or no debt?
  • Do you have disposable income?
  • Do you have a safety net of “financially stable” people in your life?
  • Do you have Citizenship in the country you live in?
These questions do not cover all circumstances, but considering them can help you decide what percent of aid you'd like to request. Here are some guidelines to help your thought process:
  • If all of your answers were yes, we suggest that you pay the full tuition. This allows us to offer this scale for those who benefit the most from our support. 
  • If your answers were mostly yes and few no, we suggest requesting around 25% of the tuition be covered by Outward Bound. 
  • If some answers were an almost evenly split of yes and no,  we suggest requesting around 50% of the tuition be covered by Outward Bound. 
  • If most answers were majority or all no, we suggest requesting 75% or more of the tuition be covered by Outward Bound. 
*These questions are based on Tanya Rumble and Nicole McVan's Community of Practice






Parent/Guardian Information (Required If Participant is Under the Age of 18)







Jr, Sr, III, etc.









Opportunities to receive text message notifications regarding the status of your Outward Bound application may vary by course and location.












Secondary Parent/Guardian Information







Jr, Sr, III, etc.



This parent/guardian will be the primary point of contact during the enrollment process. If you would like either the participant the previous parent to be the primary contact, please change your response on one of the previous pages.






Opportunities to receive text message notifications regarding the status of your Outward Bound application may vary by course and location.











Emergency Contact (Other than a parent or guardian if the participant is under 18)





Please choose an emergency contact that is different from any parent/guardians that have already been entered.




Participant Medical History: Past & Present

Next, we'll collect medical information about the participant. We recognize it may feel like we are asking a lot of questions.  Please take the time to read each question completely. 

It is important for us to get accurate medical information in order to help prepare and set participants up for success as well as for our staff to provide the best possible support during the course.

Your responses will be kept confidential and will help determine any additional forms we may need you to complete.  




Knowing a participant's sex helps our staff provide the best support, both in preparation for course and on course. The intersex option is available for applicants born with a mix of male and female biological traits.

Do any of the following conditions apply to the applicant?
If yes, please use the space provided to provide additional information, including:
  • Specific symptoms that are occurring
  • How often those symptoms or conditions occur
  • How long each symptom or condition usually lasts
  • How you care for each symptom or condition
  • Date of last occurrence of each condition
  • Any restrictions





























Do any of the following conditions apply to the participant?
If yes, please use the space provided to provide additional information, including:
  • Specific symptoms that are occurring
  • How often those symptoms or conditions occur
  • How long each symptom or condition usually lasts
  • How you care for each symptom or condition
  • Date of last occurrence of each condition
  • Any restrictions

Please indicate which conditions apply. 











Please indicate which conditions apply. 







Please indicate which conditions apply. 







Please indicate which conditions apply.













Please indicate which conditions apply. 















Please indicate which conditions apply.









Please indicate which conditions apply. 






Please indicate which conditions apply.






















Please also respond to the following questions. We will ask for more details in the following sections.





Allergies

Please list all of the participant's allergies to medications, foods, insect bites/stings, or other substances. Click Add Another Allergy to add additional allergies.



Participant Mental Health History: Within The Past Year

Do any of the following apply to the applicant within the last year? If yes, please describe.




































Medications

Please list all prescription and over-the-counter medications taken by the participant including vitamins, herbal or natural supplements and inhalers. If the participant is taking psychiatric medication, please list any medications taken or changed within the past 3 months.

If the participant is taking prescription medications, they must bring them in ORIGINAL PRESCRIPTION BOTTLES with the physician's dosage instructions.




MM/DD/YYYY



MM/DD/YYYY

Hospitalizations/Emergencies

Please list any participant hospital, psychiatric, or urgent care visits within the past year. Click Add Another Visit to add additional visits.


MM/DD/YYYY


Blood Pressure (Optional)

Please tell us about the participant's most recent blood pressure reading (must be within one year of course start date). Blood pressure may be taken with apparatus at a local grocery or drug store.

Blood pressure readings are usually reflected as a systolic value (top number) over a diastolic value (bottom number). For example, if your blood pressure is 120/80, 120 is the systolic value and 80 is the diastolic value.

MM/DD/YYYY


Additional Questions





Exercise Activity




Current Physical Activity
List the applicant's physical activity, if any. The applicant will be expected to engage in rigorous physical activity during their Outward Bound experience. Click Add Another Activity to add additional physical activities.




Additional Information


Participant Participation, Authorization and Consent for Treatment

Over the years, many students with a variety of medical and psychological difficulties have successfully completed our programs, but we must be aware of these conditions. Failure to disclose such information could result in serious harm to you (or your child) and fellow students. If you (or your child) arrive at the program start with a preexisting medical, behavioral or psychological condition which is not indicated on your medical form and you are subsequently unable to participate fully or are forced to leave the program because of that condition, you may be charged an evacuation fee and will not receive a refund of tuition.

SIGNATURE REQUIRED:
I understand the above paragraph and agree to its terms. Consent is hereby given for the applicant to attend an OUTWARD BOUND program and permission is given for any emergency anesthesia, operation, hospitalization or other treatment (whether for an emergency or not) which might become necessary. I agree to be responsible for any and all costs associated with such treatment, including the costs of evacuation, if any. All information will be kept confidential except that information may be disclosed to any medical or other provider as needed for my (or my child’s) care. If Outward Bound arranges for treatment for me (or my child) by a medical provider, I authorize that medical provider to release information about me (or my child), and my (or my child’s) condition and treatment to Outward Bound. I understand that I (or my child) may be in remote areas, several hours or days away from any medical facility or where communication, transportation, or evacuation is subject to delay.

Please type your signature below to e-sign for consent. 

Parent/Guardian Signature
By electronically typing my signature, I agree that it has the same legal effect as my handwritten signature. A child cannot sign for a parent. 

Invalid Signature Placeholder Message
Participant Signature
By electronically typing my signature, I agree that it has the same legal effect as my handwritten signature. A parent cannot sign for a child. 

Invalid Signature Placeholder Message
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