Registration

Small World Trip Registration Form

Use this form to register for a Small World Trip in Ecuador whether you are Kayaking, Rafting or Adventuring. Have your flight information, passport info, trip information and emergency contact information handy. Grand Canyoneers don't need to fill out this form but if you love forms then go for it!

Personal Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Age
Height (approx)
Weight (approx)
Birthday
Month
Day
Year

mm/dd/yyyy
Trip Information
Trip Name
Trip Date
MM slash DD slash YYYY
Primary Activity
- Kayaking
- Rafting
- Adventuring
Passport Information
Your passport needs to be valid for six months after your trip.
Passport Nationality
Passport Number
Passport Expiration
Month
Day
Year
Emergency Contact Information
Please leave the name and number of a person we can contact in the case of an emergency.
Contact Name
First Last
Contact Email
Contact Number
Contact Relationship
Medical Information
The trips are strenuous and all participants need to be in very good physical condition. We recommend that all trip participants schedule a physical exam within 2 months prior to departure. Discuss the activities and location of the trip, and take the doctor’s advice. If you are not comfortable disclosing information here then schedule a call with the office to discuss.
Physical Impairment
- Yes
- No
Do you have any physical conditions that would prevent you from fully participating in this trip? If you check Yes, please provide detail below.
Details
Please sure any details here that you think we should know. Medications you may need, allergies we should know about, recent operations, etc. Put it here or talk to us in private.
Lodge Stuff
Let us know how you like to eat, sleeping arrangements.
Diet
- Carnivore
- Vegetarian
- Vegan
Food Notes
Anything else you would like to share about your dietary restrictions, food allergies etc.
Room choices
- Request Private Room (additional $200 per week and subject to availability)
- Want to share with a particular person
- Surprise me!
If you wanted a particular roommate then enter their name here.
First Last
Flights
Name of Arrival Airline, Flight Number
Arrival Date
MM slash DD slash YYYY
Arrival Time

:
Name of Departure Airline, Flight Number
Departure Date
MM slash DD slash YYYY
Departure Time

:
River Experience
Number of years boating?
How many days have you boated this season?
List the most difficult rivers that you have boated this year. River, # of runs, water level, describe your day on the river (i.e. Easy, portaged 1)
My practice roll works
My combat roll works
I enjoy leading friends down technical runs of difficulty
I enjoy leading friends down big water runs of difficulty
I am comfortable and in control on technical runs up to
I am comfortable and in control on big water runs up to
Will you bring your own kayak?
Make three choices of kayak. Open list in new window (don't close this one) https://smallworldadventures.com/kayaks
Trip Insurance
Last question (you are so patient): Trip Insurance
- I Promise to look into trip insurance
- I have read the Cancellation policy on the Signup page
Every year we have guests that at the last moment can't make the trip for valid reasons and don't have trip insurance. Small World wants to help but we are unable to issue refunds in such situations. Please purchase trip insurance, it is not expensive and doesn't take long.
Signature
Thanks Small World Adventurer!!
Quito Hotel/Extra Notes. Please let us know where we should pick you up Sunday morning to start the trip
Anything else you would like to let us know.
Thanks, don't forget to Submit below!!
Name
This field is for validation purposes and should be left unchanged.

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Small World Trip Registration Form

Personal Information

Trip Information

Passport Information

Emergency Contact Information

Medical Information

Lodge Stuff

Flights

River Experience

Trip Insurance

Thanks Small World Adventurer!!

Thanks, don't forget to Submit below!!