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From City Boys to Urban Mountain Men Hike & Activities: Sunday, April 2, 2017: REGISTRATION FORM

— A DEEP ECOLOGY MONTH PROGRAM OF NEWARK CENTER FOR MEDITATIVE CULTURE —

LOCATION MEET-UP:
South Mountain Reservation, Bramhall Terrace, Crest Drive (about 1 mile drive off of South Orange Ave., South Orange)

LIGHT RAIN or SHINE (Heavy Rain Date April 9th)

CHECK-IN:
9:30-9:45am

PROGRAM DURATION:
10:00am-2:00pm

HIKE CO-LEADERS:
Kazi and Leslie S. Arthur

LIMIT 20 PARTICIPANTS SO REGISTER SOON!

GUIDELINES TO READ BEFORE REGISTERING (REGISTRATION FORM DIRECTLY BELOW):

IMPORTANT: PLEASE DO NOT RESERVE SPACES, USE THIS FORM ONLY IF ATTENDEES ARE CONFIRMED.

FILLING OUT FORM
- Registration deadline is Thursday, March 30, 2017.
- Please fill out one form for each adult attending.
- If you are a guardian/parent bringing up to 5 youth(s), you can use this same form to register the youths.
- To register other adults, you will be prompted by a pop-up window to enter a new form after completing this one.

WHO CAN ATTEND
- Live in urban Greater Newark Area.
- This hike is of EASY level so you need not be a hiker, just be able to walk approx. 2 miles with some grades.
- You must be male gender or identify as male.
- You must be at least 14 years old to attend this hike.
- Youths 14-17 years old must be accompanied by adults.
- We require at least one adult guardian per 5 youths.

LIABILITY
-This is an informal community program, therefore Newark Center for Meditative Culture (NCMC), The Medicine Lifestyle, Rabbit Hole Urban Farm Newark, Hikeolution, South Mountain Reservation, the Essex County Park system, and any of the individuals associated with this program will NOT BE HELD RESPONSIBLE for any injuries or loss of personal property. Please read the Liability Waiver at the bottom of this Registration Form prior to signing.

TIME RESTRICTIONS
- Please arrive between 9:30-9:45 am to check-in.
- You are required to stay for the entire program.

DONATIONS
- This workshop is free, though we welcome donations. Your generosity helps to gift the teachers and cover any expenses incurred for this program.

INFORMATION
- You will hear from NCMC a few days before the workshop with final details.
- You are also welcome to ask us any questions you might have beforehand. Email below.
- We do not share any of your personal information.

CANCELLATION
- We ask that you please cancel if for some reason you cannot attend. This helps us with our plans for food, other provisions, and concern about your whereabouts!

EMAIL: Contact us at info@newarkmeditation.org.

Registration Form
1) First Name (adult male, male identified) *
Your answer
2) Last Name (adult male, male identified) *
Your answer
3) Are you 18 years of age or older? *
4) Email Address *
If you do not have an email address, type in "none"
Your answer
5) Phone Number
REQUIRED ONLY IF YOU DO NOT HAVE AN EMAIL ADDRESS. Include area code.
Your answer
6) Address (optional)
Street, City, State, Zip Code
Your answer
7) Do you have experience hiking? *
Please answer Yes or No. If "YES", please describe, such as "very experienced", etc.
Your answer
8) Please give full name, age, and youth organization/school represented (if any) for youths (male, male identified) who you will be chaperoning. (If none, write "none" on first line.) *
One adult can bring up to 5 youths. Please list with full names and ages.
Your answer
9) Do you/your group require a ride or are you able to provide a ride? Or, do you need a lift from South Orange Train Station?
Please describe: pick-up town and needs or specific ability to provide transportation. You will be contacted.
Your answer
10) How many lunches do you/your group require? *
One per person! Vegetarian sandwiches (some with gluten-free bread) will be provided. You are also welcome to bring your own bag lunch if you prefer or if you have other food restrictions.
Your answer
11) Would you like to subscribe to receive news about NCMC programs? *
We generally email just once a week and most updates pertain to meditation programs.
12) Liability Waiver
ACKNOWLEDGEMENT OF RISKS: I waive and release any and all claims against Newark Center for Meditative Culture (NCMC), The Medicine Lifestyle, Rabbit Hole Urban Farm Newark, Hikeolution, South Mountain Reservation, the Essex County Park system, and any of the individuals associated with this program “From City Boys to Urban Mountain Men: Hike & Activities” to be held on Saturday, April 2nd, 2017 from approximately 10:00am to 2:00pm for any injury or illness (mental or physical) which may directly or indirectly result from my participation in this above mentioned program. The risks include, but are not limited to, those caused by terrain, facilities, meals, equipment, lack of hydration, temperature, weather, physical condition of individuals, vehicular traffic, actions of other people including, but not limited to, instructors, participants, volunteers and, spectators, event officials and event monitors, and/or producers of the event, as well as negligence or carelessness of any of these people. These risks are not only inherent to individuals, but are also present for volunteers. I state that I, and my wards if any, am/are in proper condition to participate in the event. NCMC reserves the right to refuse any entry.

PARENT GUARDIAN WAIVER FOR MINORS (aged 14 years through 17 years old): The undersigned parent and natural guardian, legal guardian, or chaperone does hereby represent that he/she is, in fact, acting in such capacity and agrees to release, save and hold harmless and indemnify each and all of the Entities and Persons from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said Entities and Persons because of any defect in or lack of such capacity to so act.

CHAPERONES: Each adult chaperoning youths agrees that they have received explicit permission from the parent or legal guardian of each youth with the parent's or legal guardian's understanding and approval of the above terms of liability.

ASSUMPTION OF RISKS: By checking the box below and adding my electronic signature, I acknowledge that I have read the above Liability Waiver statement and I understand its content. I hereby assume all risks of participating and/or volunteering in the above mentioned program and take full responsibility for my own and my minor-aged ward’s (if any) personal safety and personal property while attending an NCMC event.

*
Required
13) Consent to Media *
I understand that at this event or other NCMC activities, I or my wards may be photographed. Do you allow your/your wards photo, video, or film likeness to be used for any legitimate promotional purpose by the Event holders, producers, sponsors, organizers and/or assigns?
14) Electronic Signature *
Full Name
Your answer
15) Comments, questions, or things you think we might need or want to know.
Your answer
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