Hiking Club
Hiking Club provides participants with the opportunity to explore the outdoors, socializing and practice mindfulness. Participants will work together each week to decide where they will hike the following week based on a list of predetermined locations.  
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Participant's Name *
I will be attending on the following dates (select all that apply): *
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Date of Birth *
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Best Contact Phone Number *
Email Address *
Can we add you to Mobilize for communication? (app available for iPhone/Android; also works with text message or email) *
I authorize UMAISE representatives to contact me via Mobilize/email/text message: *
Emergency contact(s)- Phone number/Relationship *
Disability/Diagnosis and # of years since onset: *
Description of impairment(s); Level of injury/movement limitations; cognitive or sensory involvement (please be specific): *
On a daily basis, do you (please check all applicable): *
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Special medical considerations/allergies: *
In the event of an emergency, Michigan Medicine staff reserves the right to seek medical treatment on my behalf. Initial here: *
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