Hike to Help - Registration - January 12-13, 2019
Cell Phone #
Emergency Contact Information
Please provide a name and telephone number to contact in case of an emergency.
Backpacking equipment is available for loan. Please indicate below if you need loaner equipment.
Backpack, tent, sleeping bag, sleeping mat, hiking poles, etc...
Please make payments to Loving Community
Check - Make checks payable to Loving Community
Credit Card -
Special Dietary Needs or Restrictions
Please indicate any special dietary needs that you may have.
Please indicate any medical conditions you have by checking the below boxes.
High or Low Blood Pressure
Dizziness, fainting spells
Epilepsy or convulsions
Allergies (drugs, bees...
Back, knee, or ankle problems
Medicines Currently Taking (And will bring on trip.)
Participant’s Acknowledgement of Risks, Assumption of Risk & Responsibility, and Release of Liability
Your Responsibilities: Medical Considerations: If you have any medical or psychological conditions, it is very important you let us know well before departure so that we can make extra arrangements if necessary. Trip leaders have the right to disqualify anyone at any time during the trip if they feel the trip member is mentally or physically incapable to continue and/or if a trip member's continued participation jeopardizes the groups or his/her own safety. Under these circumstances refunds are not given. Loving Community is not a medical facility and therefore has no responsibility regarding medical advice, medications or inoculations that you or your doctor deem necessary for your safe participation. Hospital facilities for serious problems are often unavailable, and evacuation can be prolonged, difficult and expensive. Loving Community assumes no liability regarding provision of medical care. By signing the Liability Release and Assumption of Risk Agreement, you agree to pay for emergency evacuation and emergency medical care. Loving Community reserves the right to decline to accept or retain any person as a trip participant should such person's behavior, health or mental condition impede the operation of the trip. Your Obligations as a Trip Participant: By participating in Hike to Help, you assume certain obligations to Loving Community and the other participants. It is your responsibility to: Bring appropriate equipment and clothing as advised by Loving Community Follow considerate social behavior with other participants Respect the areas we visit by using environmentally safe products and practices, staying on established routes of travel, and not littering Release of Liability, Assumption of Risk and Indemnification Agreement 1. TRIP AND ASSOCIATED RISKS - I have chosen to participate in the above referenced trip (hereinafter referred to as "the Trip"), which is organized by Loving Community, Inc. I understand that: The Trip involves activities that are inherently hazardous; During the Trip, I may be exposed to dangers and hazards, including equipment failures and negligence by others; As a consequence of these risks, I may be seriously hurt or disabled or may die from the resulting injuries, and my property may also be damaged; Hospital facilities, qualified medical care, and emergency medical evacuation may be limited or unavailable during portions of the Trip and, where available, may be expensive; and Loving Community assumes no responsibility for providing medical care during the Trip, and I will have to pay for any medical care and/or evacuation costs that I incur. In consideration of the permission to participate in the Trip, I agree to the terms contained in this document. 2. ASSUMPTION OF THE RISKS - I hereby freely assume the above mentioned risks and any harm, injury or loss that may occur to me or my property as a result of my participation in the Trip-including any risks caused by the negligence of Loving Community, its employees and officers, its contractors, and other trip participants. 3. RELEASE OF LIABILITY - I hereby RELEASE Loving Community, its employees, officers, directors, vendors and contractors ("the Released Parties") FROM ALL LIABILITIES, CAUSES OF ACTION, CLAIMS AND DEMANDS that arise in any way from any injury, death, loss or harm that occur to me or to any other person or to any property during the Trip or in any way related to the Trip. This release includes claims for the negligence of the Released Parties and claims for strict liability for abnormally dangerous activities. This release does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities that Texas law does not permit to be excluded by agreement. I also agree NOT TO SUE or make a claim against the Released Parties for death, injuries, loss or harm that occurs on the Trip. 4. INDEMNIFICATION HOLD HARMLESS AND DEFENSE - I promise to INDEMNIFY, HOLD HARMLESS AND DEFEND the Released Parties (defined in Section 3) against any and all claims to which Section 3 of this agreement applies, including claims for their own negligence. I also promise to INDEMNIFY, HOLD HARMLESS AND DEFEND the Released Parties against any and all claims for my own negligence, and any other claim arising from my conduct during the Trip. In accordance with these promises, I will reimburse the Released Parties for any damages, reasonable settlements and defense costs, including attorney's fees that they incur because of any such claims made against them. I agree that in the event of my death or disability, the terms of this agreement, including the indemnification obligation in this Section, will be binding on my estate, and my personal representative, executor, administrator or guardian will be obligated to respect and enforce them. 5. OTHER FORMS & TERMS - I have carefully read and familiarized myself with all of the information provided to me about the Trip. I agree to all of the conditions including the sections about my responsibilities and about Loving Community's legal limitations. 6. SEVERABILITY - I agree that the purpose of this agreement is that it shall be an enforceable release of liability and indemnity as broad and inclusive as is permitted by Texas law. I agree that if any portion or provision of this agreement is found to be invalid or unenforceable, then the remainder will continue in full force and effect. I also agree that any invalid provision will be modified or partially enforced to the maximum extent permitted by law to carry out the purpose of the agreement. 7. APPLICABLE LAW, FORUM & ATTORNEY'S FEES - This agreement is governed by and shall be construed in accordance with the laws of the state of Texas, without any reference to its choice of law rules. In any litigation in which the validity or enforceability of this agreement is contested, I agree that the prevailing party will pay all attorney's fees and costs of the parties seeking to uphold the agreement. AUTHORIZATION FOR MEDICAL CARE: In case of medical emergency, I hereby authorize any medical treatment deemed necessary. I give Loving Community permission to hospitalize, secure proper treatment for, and/or to order injection, anesthesia or surgery for myself and/or the minor named herein. PUBLICITY RELEASE: By participating in or attending any activity in connection with this Trip or program, whether on or off the premises, I consent to the use of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotion, television, websites or any other use, and expressly waive any right of privacy, compensation, copyright or other ownership right connected to same. DRUG AND ALCOHOL POLICY: I acknowledge that Loving Community has a Zero Tolerance drug and alcohol policy and I certify that I have not consumed drugs or alcohol within six hours of this trip, and I will not do so while participating in this trip. I have fully informed myself of the contents of this agreement by reading it before signing it. No oral representations, statements or other inducements to sign this release have been made apart from what is contained in this document.
By checking this box I agree to these terms
By checking this box I do not agree to these terms
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Completion Date of Trip Registration Form
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