SIDETRACKERS is an outdoor activities club for single people in Jacksonville and Northeast Florida.  It provides a forum for singles who genuinely enjoy outdoor activities to meet like-minded single activity partners.  Club events are mostly oriented towards outdoor activities and may include camping, canoeing, hiking, cycling, sightseeing, and horseback riding.  Events and trips are varied and provide opportunities for a wide range of interests, abilities, and skill levels.  Prospective members must read, understand, agree, and sign the Release And Indemnity Agreement.  All sections of this form must be completed.  PRINT ALL INFORMATION.                                                        (1/2006)

Last Name _______________________________________ First ____________________________________

Mailing Address - Street, Apt, or PO Box ________________________________________________________

City, State, Zip_____________________________________________ Birthdate _______________________

Home Ph ____________________ Work Ph _____________________ Email Addr ______________________

EMERGENCY CONTACT.  Because some club activities include an element of risk, we require members to provide a contact person whom we may call in the event of an emergency.

Contact Name _____________________________________ Relationship ____________________

Day Ph _____________________ Evening Ph _____________________ City/State ______________________

ANNUAL RELEASE OF LIABILITY AND INDEMNITY AGREEMENT

• I, (PRINT name) ________________________________________________________ hereby state that I wish to participate in courses and/or activities offered by Sidetrackers, a non-profit organization.  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 courses and 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.  The terms of this agreement shall serve as a release and indemnity agreement for my heirs, personal representative, and for all members of my family, including any minors.
• 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: ______________________

MEMBER MEDICAL INFORMATION: If you have medical or health conditions which might interfere with your performance/participation in Sidetrackers activities, it is your responsibility to exercise good judgment.  This may include informing/discussing your condition(s), limitation(s), or other needs with trip leaders in advance of an outing.

DUES are $15.00 per year, or $7.50 after July 1st.  Checks are payable to SIDETRACKERS.  Submit or mail this application with dues (and dates/details of at least two  previously-attended club activities or events noted on the back of this page) to our membership chairman:  Judy M. 2231 Redfern Rd, Jacksonville FL 32207-3616

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