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2008
HERITAGE HIGHLANDS HIKING CLUB
MEMBERSHIP
APPLICATION AND WAIVER FORM
SUBMIT THIS
FORM and $10.00 MEMBERSHIP FEE (cash or check made payable to
“Joe Pochter”
FOR YEAR
January 1, 2008
–
December 31, 2008
to:
Joe
Pochter 13670
N. Gold Cholla Place
Marana
,
AZ
85658
Name:
_______________________________ HHH#_______________________*
*(last
5 digits of phone # plus 1 for M, 2 for F
)
Address:
_____________________________________
Marana,
AZ
85658
Phone:
____________________________
Part time: ______ Full time: _____
E-mail: (Please
print legibly)
________________________________________________
If new to the
club, date of orientation session attended: _________________
Hiking Club Disclaimer: I
understand that during outings of the Heritage Highlands Hiking Club
in which I participate under the arrangements of the Club and its
agents, certain risks and dangers may arise, including but not limited
to the hazards of traveling in the wilderness, wild animals, forces of
nature, accident and illness. In
consideration of the right to participate in this outing and the
services provided for me by the Heritage Highlands Hiking Club and its
agents, I have and do hereby assume the risk associated with the
outing and will hold Heritage Highlands Hiking Club and its agents
harmless from and defend them against any and all liability actions,
suits, claims and demands which could arise out of the outing and I
hold Heritage Highlands harmless from any loss or injury which I may
sustain in my participation in HHH.
This agreement shall serve as a release and assumption of risk
for me and my heirs, administrators, executors, and for all members of
my family including any minors accompanying me.
Transportation to and from each hike is the individual
responsibility of the participating Heritage Highlands Hiking Club
members and their eligible guests.
Hiker Responsibility:
Hikers are expected to be properly equipped and attired for the
level of hike they sigh up for. Hikers will remain with the group and
not wander off. Any hiker can request a rest stop anytime along the
hike. If a hiker becomes stressed or some medical condition arises,
he/she must inform the Hike Leader. Hikers should share with car-pool
driving duties and/or cost. Because of the ever present danger of
forest fires, smoking is prohibited while on the trails.
By my
signature below, I agree to the Hiking Club Disclaimer and will abide
by the guiding principles in the Hiker Responsibility stated above.
Also, the HHH Medical Alert Information Form is completed and
a copy is in my hiking pack.
Signature
____________________________________
Date
_________________________
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