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Pre Clinic Questionnaire
Please complete as soon as possible and forward to Horizons Unlimited at the above address at least 2 weeks prior to the start of the Clinic.
Clinic Name _____________________________________________________________
Name of Applicant _______________________________________________________
Occupation: ____________________________________________________________
Travel Information
Where will you be meeting us: ______________________________________________
How are you arriving: Driving: ___ Bus: ___ Scheduled flight: ___ Other: __________
If you are arriving by public transportation to La Ronge, would you like us to meet you there and transport you to Missinipe? _____ ($120/group)
Date/Time of Arrival: _____________________________________________________
Date/Time of Departure: ___________________________________________________
Contact Information
If for some reason (e.g. weather) the completion of the trip is delayed, you may want us to contact a spouse, relative or friend to advise them of the delay. Delays are rare, but in this event whom would you like us to contact?
Contact Name: _________________________________________
Telephone (day): _____________________ (evening): ___________________________
E-mail address: _________________________________________
Food/Diet Information
Is there anything you cannot tolerate eating that may be on the menu? _______________
Any food allergies? _______________________________________________________
Are you on any special diet? ________________________________________________
Are you partial to ___ tea, ____ coffee, ____ hot chocolate or ____ juice crystals?
Equipment Information
Are you bringing any of the following: ____ paddle, ____ PFD or ____ tent?
Do you have your own canoe? ______
Please check the items you need to rent:
_____ sleeping bag ($20/weekend) _____ thermorest ($14/weekend)
_____ canoe ($75/weekend - 2 people) _____ tent ($30/weekend)
Please forward this to Horizons at least 2 weeks before the start date of the trip. In this way we have the time to make any changes necessary to the menu.
We look forward to having you as a guest on our Clinic. We at Horizons Unlimited Wilderness Services will do everything we can to make your course with us an enjoyable and educational one. We will see you soon.
Thank-you!