Welcome Interview Form Name * First Name Last Name Email * Phone * (###) ### #### General Fitness Please state your age, height, weight, and how you feel physically about doing a Boundary Waters trip. * Survey Answer with how you are on average nowadays. No judgment, just information! I sleep well at night. Strongly Disagree Disagree Neutral Agree Strongly Agree I work out regularly. Strongly Disagree Disagree Neutral Agree Strongly Agree I am a healthy and well-rounded eater. Strongly Disagree Disagree Neutral Agree Strongly Agree I feel stressed, tired, or irritable often. Strongly Disagree Disagree Neutral Agree Strongly Agree General Comments * Please comment on the topics above, list any food allergies or preferences, and/or concerns about your general fitness for this trip. Wilderness Experience All abilities are welcome on this trip! This just allows you guide to know what skills you might be coming into the trip with. Survey Please answer based on your experience and current comfort and skill levels. I am comfortable/experienced sleeping in a tent. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced paddling a canoe using power stroke, C-Stroke, and J-stroke. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced peeing in the woods. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced cooking over a campfire or stove. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced finding firewood that is dead, downed, and dry. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced with wilderness safety, including weather, injury prevention, and wildlife. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced with Leave No Trace policy. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced with being Bear Aware with black/brown bears. Strongly Disagree Disagree Neutral Agree Strongly Agree I am comfortable/experienced portaging, navigating with map and compass, and finding campsites. Strongly Disagree Disagree Neutral Agree Strongly Agree Medical History An accurate disclosure of medical history is important for your health on trail and for the safety of the group. In the wilderness physical and emotional struggles can be amplified due to stress, environmental conditions, and exertion. Rescue is not immediate in the wilderness and often up to 48 hours away. Please answer honestly and thoroughly out of respect for yourself and the whole group. Your guide is a Wilderness First Responder and will hold your responses confidential, only to be discussed with you at your Welcome Interview. Physical Health Please check all that apply now or in the past. Diabetes Asthma Seizures Heart Condition Allergies Blood Thinners Sleep Apnea Other None that I know of. Physical Health Please elaborate on any boxes checked. Mental Health * Please check all that apply now or in the past. Anxiety Depression Trauma Psychological Diagnosis Other None that I know of. Mental Health Please elaborate on any boxes checked. Important Things To Know Before Going on Trail Some things are more exciting to deal with on trail than in the city. Let's talk openly about them for your health and the safety of the group. Yes, I am or I do or I may be... * Please check all that apply or that are possible while on trail this summer. Taking prescription medicine Taking supplements Have a special diet Have food or environmental allergies Menstruate Pregnant Other None that I know of. Please comment on any of the boxes your checked and give details regarding the topic. Thank you! We’ll talk at your Welcome Interview.
