CHALLENGE ASPEN MILITARY OPPORTUNITIES - Western Slope Socials Interest Form 
     
   
  
    
Summer 2025 to Winter 2026      Welcome, and thank you for your interest in participating in the CAMO Western Slope Socials. These events provide unforgettable adaptive recreation experiences for veterans in the heart of the Colorado Rockies.
    Before submitting, please review eligibility requirements HERE 
    If you need assistance completing this interest form, please contact us at camo@challengeaspen.org  .
    Note:  Submitting this interest form does not reserve a spot on a CAMO Western Slope Social. All responses will be kept strictly confidential. Please provide accurate and detailed information to ensure full consideration.
       
   
  
    
      
     
   
  
    
      
     
   
  
    
      PERSONAL INFORMATION 
     
   
  
    
      First Name  *   
     
    
       
     
   
  
    
      Last Name  *   
     
    
       
     
   
  
    
      Birth Date  *   
     
    
       / /  (mm/dd/yyyy)
     
   
  
    
      Gender  *   
     
    
       
       Female 
       Male 
       Transgender 
       Non-binary 
       Prefer not to say       
   
  
    
      Height  *   
     
    
       
       5' 0" or less 
       5' 1" 
       5' 2" 
       5' 3" 
       5' 4" 
       5' 5" 
       5' 6" 
       5' 7" 
       5' 8" 
       5' 9" 
       5' 10" 
       5' 11" 
       6' 0" 
       6' 1" 
       6' 2" 
       6' 3" 
       6' 4" 
       6' 5" 
       6' 6" 
       6' 7" 
       6' 8" 
       6' 9" 
       6' 10" 
       6' 11" 
       7' 0" or more       
   
  
    
      Weight (lbs)  *   
     
    
       
     
   
  
    
      Email  *   
     
    
       
     
   
  
    
      Phone (xxx-xxx-xxxx)  *   
     
    
       
     
   
  
    
      City  *   
     
    
       
     
   
  
    
      State  *   
     
    
       
       Alabama 
       Alaska 
       Arizona 
       Arkansas 
       California 
       Colorado 
       Connecticut 
       Delaware 
       District of Columbia 
       Florida 
       Georgia 
       Hawaii 
       Idaho 
       Illinois 
       Indiana 
       Iowa 
       Kansas 
       Kentucky 
       Louisiana 
       Maine 
       Maryland 
       Massachusetts 
       Michigan 
       Minnesota 
       Mississippi 
       Missouri 
       Montana 
       Nebraska 
       Nevada 
       New Hampshire 
       New Jersey 
       New Mexico 
       New York 
       North Carolina 
       North Dakota 
       Ohio 
       Oklahoma 
       Oregon 
       Pennsylvania 
       Rhode Island 
       South Carolina 
       South Dakota 
       Tennessee 
       Texas 
       Utah 
       Vermont 
       Virginia 
       Washington 
       West Virginia 
       Wisconsin 
       Wyoming 
       American Samoa 
       Federated States of Micronesia 
       Guam 
       Marshall Islands 
       Northern Mariana Islands 
       Palau 
       Puerto Rico 
       U.S. Minor Outlying Islands 
       Virgin Islands 
       Armed Forces Americas 
       Armed Forces Europe, the Middle East, an 
       Armed Forces Pacific 
       Alberta 
       British Columbia 
       Manitoba 
       New Brunswick 
       Newfoundland and Labrador 
       Nova Scotia 
       Northwest Territories 
       Nunavut Territory 
       Ontario 
       Prince Edward Island 
       Quebec 
       Saskatchewan 
       Yukon Territory       
   
  
    
      MILITARY SERVICE 
     
   
  
    
      
     
   
  
    
      
     
   
  
    
      
     
   
  
    
      HEALTH AND DISABILITY 
     
   
  
    
      
     
   
  
    
      
     
   
  
    
      
         
           
             What is your VA Disability Rating?  *   
            
          
         
           
       
       I don't have a VA Disability Rating. 
       10% 
       20% 
       30% 
       40% 
       50% 
       60% 
       70% 
       80% 
       90% 
       100%              
          
       
     
   
  
    
      
         
           
             What is your primary diagnosis or disability?  *   
            
          
         
           
       
       Amputation: Above Knee 
       Amputation: Below Knee 
       Amputation: Arm, Hand, or Finger 
       Anxiety 
       Arthritis 
       Asthma 
       Bipolar Disorder 
       Burn Injury 
       Cancer/Cancer Survivor 
       Deaf/Hard of Hearing 
       Depression 
       Diabetes 
       Dyslexia 
       Eating Disorder 
       Epilepsy/Seizure Disorder 
       Impaired Muscle Power 
       Multiple Sclerosis 
       Muscular Dystrophy 
       Parkinson's Disease 
       Post Traumatic Stress 
       Schizophrenia 
       Sexual Trauma 
       Spinal Cord Injury: Paraplegic - Complete 
       Spinal Cord Injury: Paraplegic - Incomplete 
       Spinal Cord Injury: Quadriplegic/Tetraplegic - Complete 
       Spinal Cord Injury: Quadriplegic/Tetraplegic - Incomplete 
       Stroke 
       Substance Abuse 
       Traumatic Brain Injury 
       Visual Impairment: Full 
       Visual Impairment: Partial 
       Other              
          
       
     
   
  
    
      
         
           
             What is your secondary diagnosis or disability?  *   
            
          
         
           
       
       Amputation: Above Knee 
       Amputation: Below Knee 
       Amputation: Arm, Hand, or Finger 
       Anxiety 
       Arthritis 
       Asthma 
       Bipolar Disorder 
       Burn Injury 
       Cancer/Cancer Survivor 
       Deaf/Hard of Hearing 
       Depression 
       Diabetes 
       Dyslexia 
       Eating Disorder 
       Epilepsy/Seizure Disorder 
       Impaired Muscle Power 
       Multiple Sclerosis 
       Muscular Dystrophy 
       Parkinson's Disease 
       Post Traumatic Stress 
       Schizophrenia 
       Sexual Trauma 
       Spinal Cord Injury: Paraplegic - Complete 
       Spinal Cord Injury: Paraplegic - Incomplete 
       Spinal Cord Injury: Quadriplegic/Tetraplegic - Complete 
       Spinal Cord Injury: Quadriplegic/Tetraplegic - Incomplete 
       Stroke 
       Substance Abuse 
       Traumatic Brain Injury 
       Visual Impairment: Full 
       Visual Impairment: Partial 
       Other              
          
       
     
   
  
    
      
         
           
             Can you elaborate on your diagnoses, or disability?  
            
          
         
           
      
            
          
       
     
   
  
    
      
     
   
  
    
      
         
           
             If you require a caregiver, please describe the services that they provide:  
            
          
         
           
      
            
          
       
     
   
  
    
      
     
   
  
    
      
     
   
  
    
      Challenge Aspen welcomes 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. 
     
   
  
    
      
     
   
  
    
      PROGRAM PREFERENCES & FIT 
     
   
  
    
      
     
   
  
    
      
         
           
             Please describe your experience and current skills in the activities you selected.  *   
            
          
         
           
      
            
          
       
     
   
  
    
      FINE PRINT