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Taino coqui motif

Broadstoke teal background

Climbing Tour

Spring Break Trip

March 2025

Cost: $3299.00 Please complete the questionnaire.

First name*

Last name*

Preferred Name

Birthday*

Month

Day

Year

Street Address*

City*

State*

Zip Code*

Your Email*

Your Phone*

Best Way to Contact You*

Email

Phone

Gender*

Male

Female

Nonbinary

Do you have any pre-existing medical conditions we should be aware of? If yes, please explain.*

Do you have any allergies (food, medication, insects, etc.)? If yes, please explain.*

Are you physically fit to participate in outdoor activities and moderate hiking? If no, please explain. *

Name of Emergency Contact*

Relationship to you*

Emergency Email*

Emergency Phone Number*

Preferred Roommate Name*

I would prefer:

Female Roommate

Male Roommate

Either / No Preference

Traveler Pledge

Release of Liability

Terms & Conditions

Accessibility Statement

Partner with Karaya

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All rights reserved.

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