2021 Immersive Personal Info Form

Name*
First Last
Emergency Contact #1 - Name*
Phone*
Emergency Contact #2 - Name*
Phone*
Do you have any special needs or disabilities that we can help accommodate?
What time will you be arriving and departing from Greenhorn Ranch?*
Do you have any food allergies or specific dietary needs?

Please send Veronica a picture of your insurance card at vandreades@koreventure.org.