Challenge Corner

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Name:   Date:
Organization Name:   Date Requested:
Phone:   Time Requested:
Address:   E-mail:
Program Information:
Number of Participants:   Average Age of Participants:
Do any participants have any physical/mental
limitations that facilitators need to be informed
of, if yes, please specify:
Please state three goals you would like to see accomplished by this program:
Ropes Course Information

KSU Challenge Corner has the opportunity to provide team development programs as well as
individual goal setting and challenging programs. Please indicate your preferences below:

1/2 Day Program     Full Day Program     Low Ropes Only     Low and High Ropes Combined    
Please list any additional outcomes you would like to see addressed below: