Sign-Up

Interested in booking an excursion with us?  Fill out this form.


*If you are signing up as a volunteer, please indicate that in the “Other Pertinent Info” box*

Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Do you have a physical disability?
If you have a personal care assistant, will they be accompanying you on your adventure?
Are you a military veteran?
Can you provide us a copy of your DD214?
Was your discharge honorable or dishonorable?
EMERGENCY CONTACT
Name *
Name
Phone *
Phone
Preferred adventure date?
Preferred adventure date?

Disclaimer: Application submission is not a reservation and does not guarantee selection for any Courage Incorporated event(s)