New Client - Challenge Course Inspection Request

18th Annual International Challenge Course Symposium and Conference | Portland, OR Jan 31 - Feb 3, 2008


BOLD items are required

*Contact Information*

Contact Name
Title
Email
Organization Name
Organization Website

Type of Organization

School/School District	Private/Independent	Public
Camp/Recreation Center	Non profit	Profit
Therapeutic	Non profit	Profit
Corporate	Non profit	Profit

*Address Information*

Mailing Address
Mailing Address2
City
State
Zip
Phone
Fax


*Physical Location Address for the Course (if different than mailing addresss)*


Address
City
State
Zip
Phone


*Challenge Course History*

What company built your course?

What year was it built?

What company did your last Course Inspection?

What is the date of your last Course Inspection?

Were repairs recommended on you last Course Inspection Report?

Explain

Challenge Course Description

Indoor	Outdoor	Both
Highs	Lows	Both

on poles	in trees	mixed poles & trees

Does your agency have an operating lift on-site so that the inspector can use to access indoor elements? Yes No

Number of Elements
Low: High: Total:

Equipment: (helmets, harnesses, belay gear, ropes etc.)
My gear will outfit:
            1-15 participants
            16-30
            30+

Date you need your Challenge Course inspected by

Other Services

Any other services we can help you with at this time:
Challenge Course Installation, Design or Repairs
Training and Staff Development
Props, Packs, Challenge Course equipment

Other: