T2R Application Form

    Basic Info


    YesNoIf yes, let us know below

    Emergency Contact Details

    Health and Participation


    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)


    MaleFemale

    Liability Waiver and Assumption of Risk


    [radio* your-waiverrisk label_first “I have read and agree to the Liability Waiver and Assumption of Risk.” ]

    Photo and Media Release Consent


    [radio* your-photo label_first “I consent to the use of photos/videos of me as described above.” “I do not consent to the use of photos/videos of me.” ]

    Agreement

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