Trail to Recovery Program

Basic Info

Full Name

Preferred Name/Nickname:

Date of Birth:

Your Phone Number

Your email

Mail Address

Branch of Services and years served:

Are you currently affiliated with any veteran organizations or support groups?
YesNoIf yes, let us know below

Vet Org details:

Emergency Contact Details

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Health and Participation

Do you have any physical limitations or injuries we should be aware of when planning hikes and activities?

Do you have any allergies or medical conditions we should know about?

Do you have a service animal? If yes, please provide their name and any considerations we should know to support you both:

Do you have any mental health support needs or considerations you’d like us to know about to ensure a positive experience? (Optional)
This question is optional. Sharing it helps us better support you if you ever need additional resources during program activities.
Your information is kept confidential.

What are you hoping to gain from participating in Trails to Recovery?

Do you plan on having anyone else come with you during the rides? If, yes, please list their names and emails so we can send them a Liability Waiver and Assumption of Risk.

What best describes you?
I want to be a passenger during a trail rideI have my own 4WD and want to ride with the group

Optional Demographics (For Grant Reporting & Program Improvement
Only)

Your Gender
MaleFemale

Liability Waiver and Assumption of Risk

I understand that participation in Trails to Recovery activities, including hiking and outdoor
experiences, involves inherent risks of injury, including but not limited to falls, wildlife
encounters, weather-related hazards, and other unforeseen events.
I acknowledge that I am voluntarily participating with knowledge of these risks and agree to
assume full responsibility for my health, safety, and personal property during program activities.
By signing below, I release Trails to Recovery, its staff, volunteers, partnering organizations, and
property owners from any liability or claims arising out of my participation, except in cases of
gross negligence or intentional misconduct.
I have read and agree to the Liability Waiver and Assumption of Risk.

Photo and Media Release Consent

I understand that Trails to Recovery may take photographs or videos during program activities
for the purposes of promoting its mission, sharing impact with supporters, and reporting to grant
funders.
I consent to the use of my image, voice, or likeness in photographs or videos taken during
program activities, without compensation, for use in promotional materials, social media,
website, and reports.
I consent to the use of photos or videos of me as described above.I DO NOT consent to the use of photos or videos of me as described above.

Agreement

I agree to treat fellow participants with respect at all times.I consent to Trails to Recovery contacting me about upcoming hikes, events, and related program opportunities.

Provide us VA Healthcare ID card, or a copy of their DD-214

Please upload your PDF or jpg

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