Apply Your Contact InformationName First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Date of Birth MM slash DD slash YYYY Emergency Contact InformationName First Last Relationship PhoneYour Military InformationRate / Rank MOS BranchChoose branch of militaryArmyAir ForceCoast GuardMarinesNavyStill Active DutyStill Active Duty?YesNoCurrent Duty Station Do you have a DD214?Do you have a DD214?YesNoBriefly explain why you do not have a DD214 and can you get a copy of yours? If separated from the military did you receive a Honorable Discharge?Honorable Discharge?YesNoBriefly explain why you did not receive an Honorable Discharge?Do you have:Check all that apply PTS (Post Traumatic Stress) TBI (Traumatic Brain Injury) Stress Trauma Are any of these conditions a result of military service?Choose yes or noYesNoPlease tell us about your notable military experiences, deployments-include dates, training, schools, awards, citations, etc.Health InformationDo you have any medicine allergies?Choose yes or noYesNoPlease list medicine allergies:Do you have any food allergies?Choose yes or noYesNoPlease list food allergies:Outdoor Adventure InformationDo you have any limitations, mental or physical, that will require assistance? If so, what type of assistance will you need? If a personal handler is part of your regular routine, we encourage their participation. We are able to accommodate any level of injury on some of our adventures, paraplegic and quadriplegic, wheelchairs are ok. However we must know any personal limitations in order to properly plan your event, which may include rigorous outdoor activityWhy would you like join Tadpole Foundations Outdoor Adventures? Please tell us about your outdoor experiences, if any. What do you hope to gain from joining Tadpole Adventures? It is not a requirement that you have participated in the outdoors but whatever your experience level, please tell us why you are interested. Don’t be shy we want to know your story.Which Adventure(s) are you interested in?You may choose as many as you like. June 5-10, 2022 - Pintler Mountains, Montana June 12-17, 2022 - Beartooth Mountains, Montana July 27 - August 2, 2022 - Navy SEAL only trip, Montana LimitationsBy honestly answering these questions we will be able to help ensure that you have an incredible experience on your adventure.Are you comfortable hiking at high elevations (above 10,000 feet)?Choose yes or noYesNoAre you comfortable and able to hike 7 or more miles a day?Choose yes or noYesNoCan you carry a 45lb pack while hiking 7 miles?Choose yes or noYesNoAre you comfortable sleeping in a tent in the backcountry?Choose yes or noYesNoIf you answsered no to any of the questions, briefly explain why. This will allow us to make your adventure as enjoyable to you as possible.Do you have a service dog that you would want to bring with you?Service dogs are only allowed on certain trips.Choose yes or noYesNoHiddenTadpole Foundation also has a Veteran Equestrian Program where we offer horseback riding and horsemanship once a month. It is free to attend and lunch is always provided. Location is in Norco, CA at the Norco Equestrian Academy the first Sunday of each month. Are you interested in attending?Choose yes or noYesNoAnything in addition you want us to knowPlease upload a copy of your DD214 if discharged from the military, or a copy of your ID card if active duty. Drop files here or Select files Max. file size: 256 MB, Max. files: 2. Please mark out/hide social security numbers and/or ID card numbers.PhoneThis field is for validation purposes and should be left unchanged.
