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Start the Journey

official application

Adventure Basecamp: Brushy Mountain Application

Before you begin, please take a moment to complete this application. Your responses will help us ensure that our programs align with your needs and goals, fostering a supportive environment for growth and camaraderie."

Name *

Age *

Marital Status *

Single

Dating

Engaged

Married

Widowed

Separated

Divorced

Are you a Father? *

Yes

Branch of Service *

Army

Navy

Air Force

Marine Corps

Coast Guard

None

Military Status *

Active

Retired

Veteran

Years of Service *

Rank at Discharge *

Type of Discharge *

Are you currently taking any medications we need to be made aware of? (If yes please list) *

Do you have any medical conditions we should be aware of? (If yes, please describe) *

Do you have any allergies? (If yes, please list *

Do you have any physical limitations or restrictions? (If yes, please describe) *

What motivated you to apply to Brushy Mountain? *

What are your personal goals for attending this program? *

Are you comfortable with outdoor activities and physical challenges? *

Have you ever been convicted of a crime we need to be aware of? (If yes, please provide details) *

Are you currently under any legal supervision or court orders? (If yes, please describe) *

How did you hear about Adventure basecamp Brushy mountain? *

Social Media (Instagram / Facebook)

Family Member

Friend

Colleague

Veteran Organization

Radio

Andrew Blackwell

Were you referred by someone? (If yes, please provide their name and relationship to you) *

What is your greatest attribute about yourself? *

Do you believe you are the best version of yourself? *

In which aspect of personal development do you feel there is the greatest opportunity for growth *

Is there anything else you would like us to know about you? *

Email address *

Phone number *

Emergency contact info *

Name and phone number

Instagram

@brushymountain.co

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