ABEL Intake Form -

Name

First

Last

Email

Phone Numbers

Emergancy Contact

First

Last

Relationship

Emergency Contact Phone Number

Organization / Group Name (if applicable)

Role (if group program)

Program Type

Individual
Couple
Family
Group / Corporate / Organization

Preferred Program Length

Half Day
Full Day

Preferred Date(s)

Approximate Number of Participants

Age Range of Participants

What skills or outcomes are you hoping to develop through this experience? (Checkboxes – select all that apply)

Please describe your goals or challenges in more detail.

Have participants engaged in adventure-based or outdoor experiential learning before?

Are there specific fears, challenges, or sensitivities we should be aware of?

This information helps us create a supportive and inclusive experience. No one is forced to participate in any activity.

I Approximate sensitivities

Are there any physical limitations, injuries, or accessibility needs we should be aware of?

Do any participants require activity modifications or accommodations?

Please indicate all dietary requirements or preferences (for full day programs only).

If “Other” or allergies selected, please provide details.

Is strict separation or certification required? (e.g., kosher/halal certification)

Group Dynamic - What is the general dynamic of the group?

Are there any known conflicts or sensitivities within the group we should be aware of?

Expectations & Agreements

I understand

ABEL programs are experiential, physical, and participatory in nature. Participation is always voluntary, and alternative roles or observation options are available.

I understand that participation in adventure activities is voluntary and involves inherent physical and emotional challenges.

I understand

I understand that ABEL is not therapy or medical treatment.

I understand

I agree to follow all safety instructions provided by facilitators.

I agree

ABEL Intake Form

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