Important to Read:

Please note that completing this form does not secure your spot on a trip.  Once you have completed the following, you must go to antiochfc.org/give and find the payment option for Wilderness Trip Deposits.  Upon paying the non-refundable $50 deposit and the completion of this form, your spot will be secured.  For questions, email info@antiochfc.org

Name:

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* 1. Name:

Phone:

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* 2. Phone:

Email:

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* 3. Email:

Which trip will you be attending?

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* 4. Which trip will you be attending?

What is your DOB?

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* 5. What is your DOB?

Do you think you will need to rent trip gear (i.e. pack, sleeping bag, etc)?

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* 6. Do you think you will need to rent trip gear (i.e. pack, sleeping bag, etc)?

Do you have any food allergies? (please list, and if so what is the severity for each)

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* 7. Do you have any food allergies? (please list, and if so what is the severity for each)

T