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Human Info
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Date:
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Name: first and last
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Address:
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City:
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Zipcode:
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State:
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Home phone:
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Cell phone:
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E-mail address:
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Adult 1
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Name: first and last
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Age:
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Interested in:
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Hikes:
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Morning
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Evening
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Midday
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Week
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Weekend
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Specific:
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Overnight trips
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Camping
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Backpacking
(wilderness)
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Current level of activity: frequency per week
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hike:
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none
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run:
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bike:
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other:
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Adult 2
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Name: first and last
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Age:
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Interested in:
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Hikes:
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Morning
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Evening
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Midday
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Week
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Weekend
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Specific:
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Overnight trips
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Camping
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Backpacking
(wilderness)
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Current level of activity: frequency per week
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hike:
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none
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run:
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bike:
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other:
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Children using Membership:
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Name:
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Age:
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Name:
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Age:
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Name:
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Age:
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Name:
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Age:
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Please note any medical/health issues or physical limitations that we should
be aware of for adults and children if applicable:
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Dog Info
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Dog 1
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Dog's name:
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Dog's breed:
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Dog's age:
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Activity level of Dog 1: exercise/walks/hikes/running
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often:
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sometimes
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never
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rarely
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specify:
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Dog 2
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Dog's name:
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Dog's breed:
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Dog's age:
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Activity level of Dog 2: exercise/walks/hikes/running
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often:
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sometimes
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never
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rarely
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specify:
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Dog 3
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Dog's name:
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Dog'sbreed:
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Dog's age:
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Activity level of Dog 3: exercise/walks/hikes/running
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often:
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sometimes
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never
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rarely
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specify:
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How did you hear about us?
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Waiver and Agreement to Release and Hold Them Harmless
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I, the undersigned, hereby acknowledge that I am fully aware of the nature
and purpose of the activities of K9OutdoorAdventure Club (hereafter
K9OAC). I understand that these activities are potentially dangerous and I
voluntarily accept the risks involved. I agree to be bound by the rules of
K9OAC and to obey the directions of K9OAC volunteers at K9OAC events.
As a condition of attendance at this K9OAC event I do hereby waive any
claim for liability for any injury to myself or pet, or damage to my property I
may receive a reason of participating in the K9OAC event. I voluntarily
accept all risks associated therewith and agree to hold harmless and
indemnify the Hike Leader and other K9OAC volunteers from any liability or
responsibility for accident, damage, injury or illness to myself or pet whether
or not such accident, damage, injury or illness resulted directly or indirectly
from the negligent acts or omissions of the Hike Leader and/or other K9OAC
volunteers.
K9OAC rules are posted on our web site. Please ensure to view the most
updated version as the rules may change periodically.
Pictures: We may capture you and your pet’s likeness while participating
during a K9OutdoorAdventure. By signing the participant authorizes
K9OutdoorAdventure Club the use and/or reproduce of the person’s and dog’
s likeness in print or other media. The client agrees that he/she will not be
compensated for any such use but may request and receive copies of the
print.
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Please agree, fill out your name and today's date. Thank you!
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Adult 1: Agrees to Waiver and Agreement to Release and Hold Them
Harmless
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Date:
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Adult 1 Full name:
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Adult 2: Agrees to Waiver and Agreement to Release and Hold Them
Harmless
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Date:
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Adult 2 Full name:
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Parents of Minors:
I give permission for my son(s)/daughter(s) to participate in the activities of the
K9 Outdoor Adventure Club. I waive the rights described above with respect to
the below named minor(s), and I further agree to indemnity the Club and its
volunteers from any claims arising from the participation of the below named
minor(s). Note: Parental agreement binds both the parent and any
accompanying minors to the terms of this agreement.
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Date:
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Parent or Legal Guardian of Minor
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Minor's Printed Name:
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Minor's Printed Name:
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Minor's Printed Name:
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Minor's Printed Name:
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Please ensure you have completely filled out the
"Waiver and Agreement to Release and Hold Them Harmless"
by agreeing, filling out today's date and providing your full name.
For Family Memberships please provide Adult 2 and minor's full name and
sign on their behalf. THANK YOU!
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Please ensure you have filled out the membership form.
Incomplete membership forms will not be accepted and will have to be filled out
again. THANK YOU!
Your K9 Outdoor Adventure Team
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