Group Name
Leader Name
Phone Cell Phone
E-Mail
Contact Address
City State Zip

Arrival Date Arrival Time

What would you like to Register your Group for?

	Half Day of High Ropes $300 per group up to 15 $20 for each participant over 15
	Half Day of TEAM Building $300 per group up to 15 $20 for each participant over 15
	Whole Day of High Ropes and TEAM Building $500 per group up to 15 $33 for each participant over 15

Regarding Your Group

Number of Participants Total
Number of Male
Number of Female
Age Range of Participants

Do you have any participants with special needs?

Do the participants know each other?

Very Well Pretty Well A Little Not at All

In what context does your group interact?

Work School Church Sports Friends

What team issues would this group like to explore?
(Please check up to 6)

Resource Management	Effective Feedback
Exploring Diversity	Conflict Resolution
Problem Solving Skills	Play/ Fun
Achieving Group Consensus	Physical/ Emotional Safety
Discounting/ Devaluing	Cooridnation
Confidence	Decision Making/ Choices
Timing	Team Spirit
Trust (Risk) Building	Communications
Making Mistakes	Respect People/ Property
Compromise	Balance
Cooperation	Motivation
Group Focus	Visiulization
Creativity	Support
Honesty/ Turth	Committment

Major Goals

For Leader:

For Group:

How will we know if we've met these goals?

The most challenging issue in facilitating this grou will be?

A deposit of 15% is required to secure your dates. Deposits are non refundable and non transferable. 50% of the event total is due for any cancellation within 21 days of arrival. No reservation is considered final until a deposit has been received. The balance is due upon arrival.

I fully understand and obligate myself to the above Deposits and Cancellation Policy. I certify that I have the authority to commit my group to this obligation.

Leader Signature