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Please complete and return
to:
Water Walker Sea Kayak LLC
152 Lincolnville Avenue
Belfast, Maine 04915
207-338-6424
fax: 810-963-7231
Pre-Trip Questionnaire
The
information you provide will be used to design a trip that best matches your
ability level, goals and interests as well as to help select equipment,
including kayak, paddle, and wetsuit that will be a good fit for you.
Name:
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Phone:
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Age:
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Email:
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Height:
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Emergency
contact (name & phone:
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Build:
(large / medium / small)
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Weight:
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Current level of fitness: In the last two
months, how often have you exercised for at least 20 minutes?
_____ never
_____ occasionally
_____ 1 - 2 times per week
_____ 3 - 4 times per
week
_____ 5 or more times per week
Briefly describe the extent of
your kayaking and canoeing experience (if any):
Please identify any temporary or long-term medical conditions which could
potentially become a factor during a kayaking trip:
Please identify any allergies, including allergies to insects:
Trip Goals:
Please each of the following in terms of
importance, from 1 - 10, with 10 being of maximum importance. (More than
one item may be ranked 10, for example):
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physical exercise |
______
adventure |
| ______
natural history / marine life |
______
relaxation |
| ______
exploration / discovery |
______
improve kayaking skills |
| ______
spend time with friends |
______
physical challenge |
| ______
adrenaline rushes |
______
enjoy natural beauty |
______ other: (please describe):
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