Wild West Fury Road Trip Application Name* First Last Home Phone Number*Cell Phone NumberPhone Number of Parent (emergency use only)*Student Email Address* Parent Email Address* How will you contribute to the spirit of camaraderie in the group during the trip, even in the midst of difficulties?*Are you prepared to spend several nights during the trip camping out in tents?* Are you prepared to leave your phone at home for the entirety of the trip?*Your parents will be able to contact the program staff if they need to get in touch with you. CommentsPlease include any medical or dietary needs as well as any preferences / recommendations regarding our list of potential stops on the trip.