Hiking with BIAC - Durango: Colorado Trail - Brain Injury Alliance of ColoradoBrain Injury Alliance of Colorado

Hiking with BIAC – Durango: Colorado Trail

Hiking in Durango | Best Hikes in Durango, CO | Durango.com

Join BIAC in a relaxing hike through the Colorado Trail in Durango, CO. Take some time to enjoy some mindfulness in nature as well as enjoy the company of fellow survivors of a brain injury in the surrounding area as well as BIAC staff. We will also have hiking poles to rent for the day.

Date:

Wednesday, September 22nd 2021

10:00am – 12:00pm

Cost:

Free to participate

$10 pole rental

Location:

Colorado Trail Trailhead, Durango, CO 81301

Trail Info:

Colorado Trail 9.1 mile out and back trail along Junction Creek. (We will not be completing the full trail, just a small section of it)

Duration ~ 1 hr 30min

Categorized as “moderate” we will take many breaks and not be completing the whole trail

What to Bring:

Water, Hat, sunglasses, sunscreen, decent hiking/walking shoes, rain jacket or poncho

Contact:

Michael Zavala at michael@BIAColorado.org or (720) 907-1455 for more information or any concerns

Hiking Registration – Durango: Colorado Trail

If you would prefer to pay by check, or if you have any questions, please contact Michael Zavala at 720-907-1455

Event Information
Hiking Registration*
- I need Trekking Poles but, have my own ride – $10 (15 spots left)
- I am joining and have my own ride and/or poles too
We plan to arrive at the Colorado Trailhead in Durango, CO at 10:00am
Personal Information
What is your connection to brain injury? (Person filling out form)*
- Survivor of BI
- Spouse of BI Survivor
- BI Professional
- Parent of BI Survivor
- Other Family of BI Survivor
- General Supporter of BI
- Child of BI Survivor
- Friend of BI Survivor
Are you the one that will be participating in the program?
- Yes, I am the participant
- No, I am registering for a survivor to participate
Participant Name*
First Last
Participant Date Of Birth*
MM slash DD slash YYYY
Participant Height*
Participant Weight*
Participant Mailing Address*
Street Address Address Line 2 City State ZIP Code
Participant Phone*
Participant Phone Type*
- Home
- Cell
- Work
Participant Email*
Participant Gender
- Female
- Male
Participant Race/Ethnicity
Other Race/Enthicity
Name of Family/Friend Registering Participant
First Last
Phone of Family/Friend Registering Participant
E-Mail of Family/Friend Registering Participant
Name of Provider/Professional Registering Participant
First Last
Provider/Professional Organization or Company
Phone of Provider/Professional Registering Participant
E-Mail of Provider/Professional Registering Participant
Is the caregiver, family, or friend listed above a good emergency contact?
- Yes
- No
Emergency Contact*
First Last
Relationship*
Phone Number*
Phone Type*
- Home
- Cell
- Work
Medical Information
In this next section, we need to learn a little more about the event that caused the brain injury. If you don’t know the specific answer to a question, do your best to answer it as accurately as you can. Date approximations or guesses are ok.
Click the “Add injury” button to get started.

Survivor Injury Information

Date of Injury	Cause of Injury	Actions

There are no Injuries.

How does your brain injury affect you?*
Secondary Diagnosis
Effect of Secondary Diagnosis on Survivor
Does the participant have seizures?*
- Yes
- No
Seizure Frequency
Seizure Type
Date of last seizure
MM slash DD slash YYYY
Seizure Triggers
Can the participant tell if seizure is going to occur?
- Yes
- No
Seizure Protocol
Medications
Please Provide: Name of Medication, Dose, Frequency, Effects, and Side Effects
Can Participant self-administer medications needed during activities?
- Yes
- No
Please provide more information about medication administration requirments
Mobility*
- Walks Independently
- Cane
- Crutches
- Walker
- Manual Wheelchair
- Electric Wheelchair
Communication*
- Verbal
- Non-Verbal
- ASL
Hearing
- Deafness – Right
- Deafness – Left
- Hearing Aid – Right
- Hearing Aid – Left
- Cochlear Implant
Select all that apply
Vision
Please describe any vision issues the participant may have
Additional Information
Is there anything else that we need to know or you would like to tell us?
Newsletter
- I would like to receive the Brain Injury Alliance of Colorado’s Newsletter
Payment
Admin Code
Credit Card
Card Details
Cardholder Name
Would you like to add $3 to your registration to cover credit card processing fees?
- Yes, I would like to offset the CC processing fees
- No optional fee, thanks
Billing Name
First Last
Billing Address
Street Address City State / Province / Region ZIP / Postal Code
Admin code discount
Price:
Total
$ 0.00
Product Name
Hidden field to fix the correct amount.
Click here to read our Privacy Practices
I have read and agree to BIAC's Privacy Practices*
- Yes
I acknowledge and approve this information to be shared with staff with BIAC's Recreation Department and staff for this event.*
- Yes
Phone
This field is for validation purposes and should be left unchanged.

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Hiking with BIAC – Durango: Colorado Trail

Date:

Cost:

Location:

Trail Info:

What to Bring:

Contact:

Hiking Registration – Durango: Colorado Trail

Event Information

Personal Information

Medical Information

Additional Information

Newsletter

Payment

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