I, ___________________________, hereby state that I wish to participate in courses and / or activities offered by “Off Road Hiking Club". I recognize any outdoor activity may involve certain dangers, including but not limited to the hazards of traveling in mountainous 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, “Off the Road” Hiking Club would not be able to offer its activities.

In consideration of right to participate in the activities offered by “Off Road Hiking Club", I agree to Release, hold harmless and indemnify “Off Road Hiking Club", its members and organizers 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 “Off the Road” Hiking Club. 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 certify that I am 18 years of age.

I have read this release and indemnity agreement and have fully informed myself of its contents before I have agreed by signing below.

Print Name Clearly: ______________________________________________________

User ID, (Name next to your picture on this Group's Website) ___________________________

Signature: ______________________________________________________

Date: ______________________________________________________

As with the above this section must be completed:

Your phone number: ______________________________________________________

Emergency Contact Name: ______________________________________________________

Emergency Contact Number: ______________________________________________________

(Optional) Additional information you think might be helpful in the event of an accident or medical emergency:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

(This form must be on file with “Off Road Hiking Club" prior to attending any outdoor activities with the Group. Please bring this to your next event or scan and email it directly to veryactiverj@yahoo.com.)