1. INSTRUCTIONS: Guest must read, understand, agree, and sign the Release And Indemnity Agreement
prior to participation in any club activity.  ALL sections MUST be completed.

2. GUEST INFORMATION (Please PRINT.  One person per form. Fill in all blanks and be thorough!)

Last Name _____________________________ First _____________________ Middle __________________
Mailing Address
(Street and Apt or PO Box) __________________________________________________________________

City, State, Zip ____________________________________________________________________________

Birthdate ____________________ Home Ph ____________________ Work Ph ________________________

Emergency Contact Name ___________________________________   Phone __________________________

3. TYPE OF ACTIVITY

_________________________________________________________________________________________
Describe activity clearly and specifically, using additional space as needed.

4. GUEST RELEASE AND INDEMNITY AGREEMENT

I, (PRINT name) ________________________________________________________ hereby state that I wish to participate in courses and/or activities offered by Sidetrackers, a non-profit corporation.  I recognize and understand that any outdoors activity may involve certain dangers including (but not limited to) the hazards of traveling in wilderness terrain, accidents or illness in remote places, forces of nature, and the actions of participants and other persons.  I further understand and agree that without some program providing protection of its assets and its leaders, Sidetrackers would not be able to offer its activities.

In consideration of and as part payment for the right to participate in the activities offered by Sidetrackers, I agree to RELEASE, HOLD HARMLESS AND INDEMNIFY Sidetrackers and its members from any and all liability, claims, and causes of action arising out of or in any way connected with my participation in any activities offered by Sidetrackers.  I personally assume all risks in connection with these activities. 

I have read this release and indemnity agreement and have fully informed myself of its contents before I have signed it.  This agreement will remain in full force and effect until cancelled or withdrawn in writing by the undersigned.

Signature of Participant: _______________________________________ Date: ________________________

5. GUEST MEDICAL INFORMATION: Do you have any medical or health conditions which might interfere with your performance/participation in Sidetrackers activities for which you have registered or signed-up? No Yes
If YES, you must elaborate on the back of this page.   Emergency contact information may be required.