Please complete and return to:
           Water Walker Sea Kayak LLC
           152 Lincolnville Avenue 
           Belfast, Maine  04915
           207-338-6424
           fax:  810-963-7231


Pre-Trip Questionnaire
The information you provide will be used to design a trip that best matches your ability level, goals and interests as well as to help select equipment, including kayak, paddle, and wetsuit that will be a good fit for you.

Name:       

Phone: 

Age:

Email:

Height:

Emergency contact (name & phone:

Build: (large / medium / small)

Weight:

Current level of fitness:  In the last two months, how often have you exercised for at least 20 minutes?
_____ never
_____ occasionally
_____ 1 - 2 times per week
_____ 3 - 4 times per week
_____ 5 or more times per week

Briefly describe the extent of your kayaking and canoeing experience (if any):





Please identify any temporary or long-term medical conditions which could potentially become a factor during a kayaking trip:





Please identify any allergies, including allergies to insects:




Trip Goals:

Please each of the following in terms of importance, from 1 - 10, with 10 being of maximum importance.  (More than one item may be ranked 10, for example):

______ physical exercise ______ adventure
______ natural history / marine life ______ relaxation
______ exploration / discovery ______ improve kayaking skills
______ spend time with friends ______ physical challenge
______ adrenaline rushes ______ enjoy natural beauty
______ other: (please describe): ___________________________________________________________________