Challenge Course Program Request

We will contact you to arrange payment. Accepted methods include check, credit card, and departmental transfer (FOP).

Contact Person Information

Contact person Required

Day phone Required

Evening phone Required

Address Required

City Required

State Required

Zip Required

Email Required

Group Information

Group name Required

Number in group Required

Age range Required

How long has the group been together? Required

Will they know each other’s names? Required

Yes

Approximate overall fitness level of the group Required

Athletic

Active

Average

Below Average

Poor

What specific issues are important for this group? Please rank as a 1, 2, or 3 for all that apply Required

Questions	1	2	3	NA
Goal setting Required	1	2	3	NA
Problem solving Required	1	2	3	NA
Decision making Required	1	2	3	NA
Teamwork Required	1	2	3	NA
Self-Confidence Required	1	2	3	NA
Creativity Required	1	2	3	NA
Socialization / Getting to know each other Required	1	2	3	NA
Leadership Required	1	2	3	NA
Peer Respect Required	1	2	3	NA
Trust Required	1	2	3	NA
Risk Taking Required	1	2	3	NA
Commitment Required	1	2	3	NA
Communication Required	1	2	3	NA

What are the group’s strengths and weaknesses? Required

Group Objectives Required

Please describe the end result that you envision for your groups’ challenge program experience. Course objectives may include reference to: trust, communication, and working roles. Issues such as active participation, risk taking, responsibility, challenge and support may also be addressed.

Program Information

Program type Required

Low Ropes Program

Climbing Rappelling Tower

Teambuilding

Desired length of program Required

Desired dates and times for program Required

Are there any limitations or health concerns we should be aware of when designing your program? Required

Please list any specific goals for the program that may be different or more specific then your objectives previously listed. Required