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Your Contact Information

Required fields = *
*First Name:  
*Last Name:  
*Address 1:  
Address 2:  
*City:  
*State:  
 *Zip/Postal Code:  
*Country:  
*Home Telephone:   (include international and area code)
Summer Telephone:   (include international and area code)
*E-mail Address:  
*Gender:
Male    
Female    
*Will you be at least 18 years old on September 1, 2008?
(If no, please complete the parents permission form)   
Yes    
No    
*Preferred t-shirt size:       
S    
M    
L    
XL    
 

Emergency Contact Information

Contact 1:
We will contact this person first in the event of an emergency.
*Full Name:  
*Relationship to you:  
*Home Telephone:  
*Work Telephone:  
Pager/Cellular Phone:  
Contact 2:
We will contact this person first in the event of an emergency if we are unable to reach your first contact person.
*Full Name:  
*Relationship to you:  
*Home Telephone:  
*Work Telephone:  
Pager/Cellular Phone:  

Experience

Trips appropriate for all skill and comfort levels are offered. In order to best meet your individual needs, please answer the following questions as accurately as possible. Vague or misleading information may result in a trip placement that is beyond your skill/comfort level.
*On a scale of one to ten, please rate your outdoor skill/comfort level:
   
1    
2    
3    
4    
5    
6    
7    
8    
9    
10    

*Please list experience you have which is relevant to the trip preferences you indicated.
Include both organized trip experience (e.g., NOLS, Outward Bound, Wilderness Summer Camp) and individual experiences. The information you provide will be used to place you on an appropriate trip.
 

Medical Information

*Please list any serious allergies and/or dietary restrictions (i.e., bee stings, nuts, shellfish, penicillin, etc.)
 
*Do you gave asthma?   
Yes    
No    
 
  If yes, do you carry an inhaler?   
Yes    
No    
 
*Are you an insulin-dependent diabetic?   
Yes    
No    
 
*Do you have epilepsy or any other seizure disorder?   
Yes    
No    
 
*Please list any prescription medications you take regularly:
 
*Do you have any other medical conditions (i.e., orthopedic problems, eating disorders, sun sensitivity, etc.) that might affect your participants in outdoor activities such as hiking, biking, swimming, or canoeing?
 

Trip Preference

*Please select your top three trip type preferences and difficulty level (if applicable).
1.  
2.  
3.  
4.

Backpacking:
Level 1 = High level of difficulty, hiking experience necessary.
Level 2 = Moderate difficulty, some hiking experience preferred
Level 3 = Low level of difficulty, no experience necessary, beginners welcome

Road Biking:
Student must provide their own road bike and helmet. Some experience preferred.

Important Notes

You will be responsible for providing a sleeping bag and frame pack for all trips unless specifically notified otherwise. For biking trips, you are expected to provide your own bicycle and helmet. For fishing trips, you must provide your own rod and tackle. A complete trip-specific equipment list will be included in your trip placement mailing.
  Please check here if you think you might need assistance getting the equipment for your trip. If you indicate that you will need help, the COOT2 coordinator will contact you.
All trips are available on a first-come, first-served basis. Trip preference and past experience will be used to place students on the most appropriate COOT2 trips.
Please register as soon as possible, but we cannot assign you to a trip until your health form, immunization form, and parents permission form have been completed and returned..

For fastest service, please return both forms together to:

Benjamin Green
COOT2 Coordinator
Colby College
5900 Mayflower Hill
Waterville, ME 04901-8859

Any Questions?
Contact the Office of Campus Life at (207) 859-4286, Monday-Friday, 8:30 a.m.- 4:30 p.m., EST or via e-mail Benjamin Green (bbgreen@colby.edu)