CHALLENGE ASPEN MILITARY OPPORTUNITIES - ROCKY MOUNTAIN RETREAT APPLICATION

We require that you complete the information below with accurate and detailed responses in order to be considered. All applications received by Challenge Aspen are strictly confidential.

PERSONAL

First Name *

Last Name *

Birth Date *

// (mm/dd/yyyy)

Gender *

Height *

Weight (lbs) *

Email *

Phone (xxx-xxx-xxxx) *

City *

State *

Preferred Airport(s) *

Employment Status *

Please provide a short biography, with a little history and what you are currently up to. *

How do you feel a CAMO Retreat would benefit your life right now? *

Have you attended a Challenge Aspen CAMO Retreat before? *

No
Yes, I've attended 1
Yes, I've attended 2 or more

Do you understand that "Introduction" retreats are only open for veterans who have never attended a CAMO retreat before.

Yes, I understand.

Do you understand that "Advanced" retreats are open to new, and alumni veterans, and that participants are required to get themselves to the retreat location.

Yes, I understand, and am willing to provide my own transportation.
Yes, I understand, but providing my own transportation isn't financially possible for me.

Are you willing to pay a $100 refundable deposit if offered a spot on a retreat.

Yes
No

How did you hear about Challenge Aspen Military Opportunities? *

Word of mouth
Therapist or medical professional
Email
Print flyer
Social Media
Referred by friend*

*Who referred you?

MILITARY SERVICE

Status *

Active Duty
Reserves
Veteran/Retired

What branch(es) of the Military did/do you serve in? *

Army
Air Force
Marine Corps
Navy
Coast Guard
Space Force

Briefly describe your job/MOS: *

What year did you separate/retire from the military? (if still in, enter N/A) *

How many total years did you serve? *

Are you able to provide a copy of your form DD214 and VA rating letter? *

Yes
No

Are you barred from receiving VA benefits or compensation for any reason? *

Yes
No

HEALTH AND DISABILITY

How would you describe your current level of mental health? *

Poor
Fair
Good
Excellent

How would you describe your current overall physical fitness? *

Poor
Fair
Good
Excellent

Would you care to elaborate on your current mental health, or overall physical fitness?

What is your VA Disability Rating? *

What is your primary diagnosis or disability? *

What is your secondary diagnosis or disability? *

Would you care to elaborate on your VA disability rating, diagnoses, or disability?

Are you able to handle your own bathroom & self care needs? *

No, I require a caregiver to assist me
Yes
Yes, but I require ADA accommodations

Do you require or use a mobility device? *

No
Walker/Cane
Manual Wheelchair
Electric Wheelchair

If you use a mobility device, are you able to transfer in to a vehicle seat?

No
Yes

Challenge Aspen allows service dogs that are individually trained to do work or perform tasks for people with disabilities. Emotional support dogs and self-trained service dogs are not allowed. Please talk with the CAMO staff before making the decision to bring your service dog.

Do you have a service dog? *

No
Yes, but I'd plan to leave it at home
Yes, and I'd plan to bring it

PROGRAM PREFERENCES & FIT

My FIRST choice of a CAMO retreat would be... *

Mountain Biking
Archery
Fly Fishing
Summer Sports Sampler
Ski / Snowboard

My SECOND choice of a CAMO retreat would be... *

Mountain Biking
Archery
Fly Fishing
Ski / Snowboard

What is your mountain biking experience level? *

None - I can't ride a bike
Beginner - I can ride on mellow gravel paths or dirt roads
Intermediate - I can ride dirt trails with some climbing and descending
Advanced - I slay technical singletrack with authority

What is your fly fishing experience level? *

None - I've never tried fly fishing
Beginner - I have tried fly fishing, and understand the basics
Intermediate - I can actively fish and use all equipment
Advanced - Fish fear me

What is your archery experience level? *

None - I've never picked up a bow
Beginner - I've shot a few arrows
Intermediate - I'm able to reliably put arrows on target
Advanced - I'm a seasoned archer or bowhunter

What is your preferred snowsport: *

Unsure
Skiing
Snowboarding
Adaptive Ski Equipment*

*Please describe adaptive ski equipment you have used before, or would like to use:

What is your preferred snowsport experience level? *

None - I am new to snowsports.
Beginner - I can make turns, come to a stop, and am comfortable on green circle terrain
Intermediate - I can connect turns, emergency stop, and am comfortable on blue square terrain.
Advanced - I can comfortably ski all terrain including black diamond - I'm a ripper

FINE PRINT

I agree I am applying to participate in outdoor recreational and non-medically supervised programming. Participation includes activities that can be hazardous and involve risk of physical injury and/or death. I attest my current medical condition allows participation in these activities: *

Yes
No

I attest I have provided Challenge Aspen with ALL medical and disability information thereby allowing Challenge Aspen to make informed and safe decisions regarding my possible participation: *

Yes

I understand that I will be required to sign a waiver and liability release before participating in any Challenge Aspen activity. *

Yes

By selecting "Yes" below, and hitting the Submit button, I understand and agree that I will not be considered to attend a program if the information I have provied above is not complete, honest, and accurate. *

Yes

Timeout Warning

CHALLENGE ASPEN MILITARY OPPORTUNITIES - ROCKY MOUNTAIN RETREAT APPLICATION

PERSONAL

MILITARY SERVICE

HEALTH AND DISABILITY

PROGRAM PREFERENCES & FIT

FINE PRINT