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Thank you for your interest in a GOALS wilderness river program. Our expeditions provide unique and rewarding experiences that foster personal growth. Completing this application is your first step toward discovering all of the lessons held within the canyons we explore.

Please note:
After your application has been submitted and reviewed, you will receive a confirmation email. GOALS program availability is very limited due to restrictions on group size imposed by the permits necessary to travel through the canyons where our programs take place. As a result, your space is not reserved until:

1. This application has been reviewed and labeled complete.
2. A $250 deposit has been received. This can submitted online after you have verified your email and thereby received confirmation of this completed application.

Once you have submitted a deposit, your application will be considered complete. Please be aware that since access to the river canyons where our programs occur is very limited, your deposit will not be refunded by GOALS unless the reason for withdrawal is deemed by the GOALS Board of Directors to be a verifiable medical or family emergency.

 

Please select who will be joining us in the canyon...
AdultMinor
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Email address for youth participant (different email than parent/guardian, when applicable).
Age at the time of program launch:*

Please enter your height and weight so that we can provide you with a properly fitting personal flotation device for your river program.  

Height:*
Weight*
Grade in school:*
Name of the school/group you will be joining in the canyon:*
Which river/canyon are you applying for?*

What is the specific launch/permit date you are applying for? *
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent / Guardian Assisting

Name of Parent / Guardian(s) assisting in the completion of this application *

Email address for parent / guardian
Emergency Contacts

Emergency Contact #1. Please list an emergency contact OTHER THAN the parent/guardian who will be contacted in the event that the parent/guardian can not be reached. *

Relationship of this emergency contact to the participant (i.e. aunt, family friend, neighbor, etc.). *

Phone option #1 for this emergency contact. *

Phone option #2 for this emergency contact (if available).

Emergency Contact #2. Please list an emergency contact OTHER THAN the parent/guardian who will be contacted in the event that the parent/guardian and Emergency Contact #1 can not be reached. *

Relationship of this emergency contact to the participant (i.e. aunt, family friend, neighbor, etc.) *

Phone option #1 for this emergency contact. *

Phone option #2 for this emergency contact.
Health Information.

The information provided in this section of the GOALS application is shared only with GOALS staff and professional guides for whom the information is vital to ensure that we can provide the best care for each program participant.  

Please fill out this section completely - and be sure to advise GOALS of any changes that might occur between the time this application is completed and the departure of the GOALS wilderness river program.  

Is the participant for whom this application is being completed currently experiencing OR have you ever had any of the following?  
(If yes, please describe each in the blank text box following the list of medical conditions).

Heart condition*
No
Yes
Chest Pain / Pressure*
No
Yes
Recurrent shortness of breath*
No
Yes
Asthma / Respiratory Condition*
No
Yes
Recurrent Dizziness / Fainting*
No
Yes
Blood Disorder / Disease*
No
Yes
Blood Pressure Problems*
No
Yes
Muscular / Skeletal Disorder*
No
Yes
Sleep Disorder / Sleepwalking*
No
Yes
Currently Pregnant*
No
Yes
Diabetes / Hypoglycemia*
No
Yes
Severe Headaches / Migraines*
No
Yes
Gastrointestinal Problems*
No
Yes
Urinary Tract Problems*
No
Yes
Seizure Disorder / Epilepsy*
No
Yes
Depression / Anxiety*
No
Yes
Past Head Injury*
No
Yes

Please list and describe any medical conditions that were not listed above, and/or provide descriptions of any conditions for which you answered "yes" above.
Does this participant have any severe NON FOOD-RELATED allergies - especially anaphylactic? (Please note: participants must provide their own epi-pen).*
No
Yes

If you answered "yes" above, please describe each.
Has this participant ever been hospitalized overnight?*
No
Yes

If you answered "yes" above, please describe when and why.
Does this participant have any activity limitations?*
No
Yes

If you answered "yes" above, please describe.

Please list all prescription medications currently being taken by this participant.  Participant must communicate with their Adventure Leader (teacher organizing the program from their school) regarding their ability/inability to administer their own medications.  Please also provide an extra set of medications to the Adventure Leader in case of loss or damage by the participant.  

For each medication, please list: 
- Drug name
- Purpose
- Dosage
- Frequency


Prescription Medications List.
Is this participant currently undergoing professional counseling, or have they been diagnosed with an emotional/psychiatric disorder that GOALS staff members should be aware?*
No
Yes

If you answered "yes" above, please describe the condition and its' potential to affect the participant or their group in a wilderness setting.

While not required, it may be helpful in the event of a medical emergency to have information regarding this participant's physician and health insurance information. 

It is not required by GOALS that each participant have medical insurance, but each participant and/or their parent/guardian is responsible for any medical expenses and should ensure coverage by his/her own health care or accident insurance provider.    


Name of the primary care physician for this participant

Phone number for the primary care physician for this participant

Insurance Company Name

Name of Policy Holder

Policy Number

Group Number

Phone Number for Insurance Provider

By initialing below (by parent/guardian), you are indicating that you have answered each question in the Health Information Section of this application completely and to the best of your knowledge.  


Parent/Guardian initials *
Medical Release

By initialing below (by parent/guardian), you are indicating that in the event of an accident or illness which requires medical care for this participant, of whom you are a parent or legal guardian, you hereby give permission to attending medical personnel and GOALS: officers, directors, employees, representative agents, volunteers, contract individuals, partnering outfitters and their staff, and all other persons or entities associated with it the full power in consent to any and all necessary medical treatment.  


Parent/Guardian initials *
Dietary Restrictions / Allergies

Please list all FOOD-RELATED ALLERGIES that this participant has, and describe the severity of the allergic condition.  (Please note: if anaphylactic, participants must provide their own epi-pen)..  


Food-related allergies:

Please list any dietary restrictions that should be considered when menu planning for this program to accommodate your preferences (i.e. vegetarian, gluten-free, etc.):


Dietary Restrictions
Personal Contract - to be completed by Participant

To the GOALS participant:

Access to the rivers on which we travel is highly limited - thus participation is a privilege and access to GOALS river programs is generally quite competitive.  By signing your initials at the bottom of this section, you are committing to conduct yourself in an appropriate manner as a GOALS participant, and agreeing to comply with the following requirements and expectations.

I agree to:

- complete ALL of my pre-trip requirements, as specified by the Adventure Leader. 

- arrive at my program launch with the necessary equipment, as defined by the GOALS suggested packing list.

- make the trip fun and safe for everyone by first recognizing the difference between healthy risk taking and unhealthy risk taking, then embracing healthy risks and avoiding unhealthy risks. 

- be flexible, patient, and open in the face of new and challenging situations.

- be respectful of all other people in your group, including professional river guides and chaperons.

- be respectful of the natural environment and ancient artifacts encountered on the river.

- be respectful of and properly care for all equipment on trip.

- forgo the use and/or possession of weapons, tobacco products, drugs or alcohol.

- dress appropriately at all times.

- leave behind ALL electronic devices (with the exception of cameras).  Phones may NOT be taken along to be used as a camera.

- participate positively and fully in all group meetings and activities, and to take an active role while camped in the canyon by helping out whenever and wherever possible.

By initialing below (by participant), you are indicating that you have read and fully understand the requirements and expectations above.  You acknowledge that if, at any time, a GOALS representative, chaperon, trip leader, or professional river guide have cause to believe that you pose a risk to the group's overall safety in a wilderness environment because you are unwilling to follow or have willfully disobeyed directions, safety rules, the law, or that you represent an unacceptable risk to him/herself or to others in any way, that you may be separated from the group as soon as possible and evacuated from the trip by raft, on foot, or by helicopter under safe escort.  In such an event, the costs of your GOALS program will not be refunded, and the cost of such emergency evacuation will be borne solely by you and/or your parents/guardians.  Additionally, you may be held legally responsible if laws are broken while participating in a GOALS program, and are aware that such violations will be reported to law enforcement agencies immediately. 



Participant initials - indicating agreement. *

Parent / guardian initials - indicating understanding. *
Short Answer / Essay Questions - to be completed by Participant

Please answer the following questions thoroughly.  This is a requirement for all participants, and is sometimes and important part of the selection process when permit space is limited. 


Please tell us specifically why you want to participate in a GOALS wilderness river program? *

What part of the GOALS river program are you most excited about? Why?? *

What part of the GOALS river program makes you the most nervous? Why?? *

Is there anything else that you feel is important for GOALS to know about you?
Parent/Guardian Permission to Participate - to be completed by parent/guardian

There are inherent risks involved with participating in a GOALS program.  We, along with the commercial outfitters with whom we partner, make every reasonable effort to minimize the risks that are within our control, but it is your responsibility to become informed about them and then to make a deliberate choice in supporting your son/daughter's participation.  Please be aware that:

- GOALS programs are open to all youth - we do not perform background checks on our youth participants.  Rather, we rely on your good judgment as a parent/guardian not to involve your minor in our programs if you believe he/she could pose a potential behavioral or safety risk to other participants. Failure to do so could make you liable.

- GOALS is not directly associated with any public or private school system. We are a private, non-profit organization incorporated in Colorado. As such, we have the right to exclude any participant who we believe, at our sole discretion and for any reason, could pose a risk to him/herself or other participants beyond our ability and resources to manage within an appropriate standard of care.

- Please be aware that if the Program Coordinator(s), chaperon(s), trip leader(s), or professional river guide(s) have cause to believe that any participating youth is unwilling to follow directions, safety rules, the law, or represents an unacceptable risk to him/herself or to others in any way, that youth may be separated from the group as soon as possible and evacuated from the trip by raft, on foot, or by helicopter under safe escort. The cost of such emergency evacuation will be borne solely by the parents/guardians. Additionally, youth may be held legally responsible if they break any law while participating in a GOALS program - such violations will be reported to law enforcement agencies immediately.

- Please talk with your son/daughter about 1) how important it is to follow all rules, warnings, and "safe practices" that GOALS and their professional river guides will teach them and 2) that if your child feels unsafe or uncomfortable for any reason, they should report their concerns to one of the adult supervisors immediately.

- The professional river guides that operate GOALS river programs have first aid training. They are not medical professionals, physicians or nurses. Your son/daughter is responsible for remembering to take & administering their prescription medications, even when placed under the control of their professional river guides or chaperons for the duration of the river program.

- It is neither possible nor desirable to eliminate all risks involved in participation of the program.  

By initialing below (by parent/guardian), you are indicating that you have read and acknowledge the risks detailed in this form and consent to your child's participation in a GOALS program knowing of these risks.  Further, you are indicating that your child understands the requirements and expectations in the participant's personal contract, and that your child does not pose any behavioral or safety threat to others involved in the GOALS program. He/she fully understands and will adhere to all rules and warnings during the course of the program.


Parent/Guardian initials - indicating agreement. *
GOALS Participant Agreement, Release, and Assumption of Risk

In consideration of the services of GOALS, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "GOALS"), I hereby agree to release, indemnify, and discharge GOALS, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representatives and estate as follows:

1. I acknowledge that going on a guided river trip and all other activities related to participation in a GOALS program entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property or to third parties. I understand that such risks cannot be eliminated without jeopardizing the essential qualities of the activity.

The risks include, among other things: whitewater rapids and turbulent water, river currents will be encountered. I can be jolted, jarred, bounced and shaken about during rides through some of these rapids. It is possible that I could be injured if I come in contact or collide with storage containers, boat frames, oars, oarlocks or other fixed equipment necessary to the operation of the expedition and the outfitting of the raft. Rafts could capsize or I could be "washed" overboard into the water. I can slip or fall during a hike, at camp or on a boat, resulting in damage to equipment or personal injury. Accidents can occur getting on and off the raft. Rafts are slippery when wet. Exposure to the natural elements can be uncomfortable and/or harmful. I am aware that this exposure could cause sunburn, dehydration, heat exhaustion, heat stroke, heat cramps and death. Prolonged exposure to cold water can result in cold shock or hypothermia and in extreme cases can cause death and accidental drowning. GOALS is not responsible for the acts of nature, including but not limited to contact with flora & fauna. Furthermore, the professional river guides operating GOALS river programs employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather or environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction. In addition, there are risks involved in traveling to and from the river or other destinations as well as completing the necessary pre-trip requirements such as but not limited to community service and fundraising requirements. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate regardless of the risks.

1. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless GOALS from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of GOALS equipment or facilities, including any such claims which allege negligent acts or omissions of GOALS.

2. Should GOALS or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

3. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating and I agree to bear the costs of such injury or damage to myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

4.  I recognize that GOALS is not associated directly with any school district or other youth organization from which GOALS groups are assembled.  Participation by a group of youth from a particular school or other youth organization does not indicate direct involvement or acceptance of liability by such school districts or youth organization.  I hereby agree to release, indemnify, and discharge such organizations from liability associated with all risks described within this agreement. 

5. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.




Participant initials - indicating agreement.

PARENT'S OR GUARDIAN'S INDEMNIFICATION (Must be completed for participants under the age of 18)

In consideration of the minor for whom this application is being completed being permitted by GOALS to participate in its activities and to use its equipment and facilities, I agree to indemnify and hold harmless GOALS from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.  By signing this document, I acknowledge that if anyone is hurt or property is damaged during participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against GOALS on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.


Parent / Guardian initials for minor participants - indicating agreement.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Email address for youth participant (different email than parent/guardian, when applicable).
Age at the time of program launch:*

Please enter your height and weight so that we can provide you with a properly fitting personal flotation device for your river program.  

Height:*
Weight*
Grade in school:*
Name of the school/group you will be joining in the canyon:*
Which river/canyon are you applying for?*

What is the specific launch/permit date you are applying for? *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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