Please enter your responses below.

Name *
Name
Are you afraid of heights? *
Are you afraid of darkness? *
Are you claustrophobic? *
Do you have difficulty climbing stairs? *
What are your thoughts on walking?
Are you sensitive to loud noise? *
Have you ever received a citation for biometric interference ("Aloning")? *
All responses are confidential
Have you ever been arrested for biometric interference ("Aloning")? *
All responses are confidential
Have you ever Aloned legally, for medical reasons? *
All responses confidential
ie. medical conditions, special needs or any pertinent info that may affect your experience.
Waiver and Release of Claims *