On-line Pre-Registration Form
To register for our 2012 Teen or Adult adventures with River Discovery please provide us with the information in the form below. Open recruitment and pre-registration for this trip is now open until April 15, 2012. On April 15th we will select participants via lottery. The lottery selection is dependent on the number of new participants requests received -- Return participants will be wait listed until a spot opens up and then selected via lottery. Once selected each participant will be notified and asked to complete and return appropriate paperwork to secure his/her spot. All paperwork will be due to River Discovery by noon on June 1, 2012.
You will have the opportunity to review your information for accuracy.
NOTE:
fields with an
*
are required.
Adventure:
*
Select One
2012 Teen Adventure for Cancer Survivors
Dates TBD, for teen cancer survivors
Ages 13 to 17 -or- a 2011/2012 high school senior
15 total participants
2012 Adult Adventure for Cancer Survivors
September 1 - 7, for adult cancer survivors
Ages 18 and over
15 total participants
First Name:
*
Last Name:
*
Parent, legal guardian or spouse's name:
*
Address:
*
City, State, Zip:
*
Phone:
*
Email:
*
Age:
*
Date of Birth:
*
DD/MM/YYYY
Gender:
*
Male
Female
Diagnosis:
Diagnosis Date:
DD/MM/YYYY
Referred by:
*
Upcoming Events
June 10 BBQ Pictures
July 15 Raffle Winners
July 15-21 Teen Adventure
Sept 1-7 Adult Adventure
Nov 1 Terry Lanni Memorial Quilt Raffle Winner
See all
River Discovery · P.O. Box 8336, Boise, ID 83707
Phone: (208) 303-0040 · Email:
riverdiscovery@gmail.com
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