Apply for your adventure using the form below!
Full name
Your email
Phone Number
City and Province
Gender and Pronouns
Birthdate
Occupation
Disability
Why do you NEED this experience?
How could this change your life?
How do you feel your disability holds you back?
Why are you ready for this NOW?
Describe your personality, the good, and the bad!
What are some of your greatest accomplishments?
Three fun facts most people do not know about you?
Pick three words to describe yourself:
What are the hardships and obstacles you have had to over come?
If you'd like, you may include a link to your social media, or to a video, or photo of yourself here.