Canoe & Kayak Club
PHONE: Residence: ______________; Work: ___________; FAX: _________________
E-mail address: ______________________________________________________________
CHILDRENS' NAMES AND AGES:___________________________________________
BUSINESS OR PROFESSION:_________________________________________________
WATER CRAFT PADDLED: Kayak ________ Canoe __________ Other ___________
INTERESTS AND COMMENTS:________________________________________________
(Signature Required To Validate Membership)
I realize that participation in activities of the HILL COUNTRY PADDLERS CANOE CLUB may result in injury or illness due to accidents, the force of nature, or other causes not foreseeable. Such injury or illness may include, but is not necessarily limited to, disease, strains, sprains fractures, dislocations, paralysis and/or death. Possible injuries may cause serious and permanent disability. I do recognize this risk, and by my participation in these activities, I hereby knowingly assume the risks arising out of each activity.
On behalf of myself, my heirs, executors, administrators and personal representatives, I hereby agree to hold harmless and without fault, release and indemnify HILL COUNTRY PADDLERS CANOE CLUB and its officers, directors and employees, trip organizers, leaders, agents, employees and instructors from any and all liabilities, claims and suites for bodily injury, illness, property damage, wrongful death, loss of services or otherwise which may arise out of my participation in the activities, whether or not such claims or suits arise from negligent acts by the organizers and conductors of the activities, their employees or volunteers, another participant, or any other person or from any cause, and do hereby WAIVE any remedy I may have, in law or in equity. This Waiver of Liability is in effect as pertains to each activity, to and including while in transit to and from each activity, and while participating in each activity.
I HAVE READ THE ABOVE WAIVER AND RELEASE. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT VOLUNTARILY:
SIGNATURE:_____________________DATE OF BIRTH:___________DATE:___________
SIGNATURE OF PARENT OR GUARDIAN IF PARTICIPANT IS LESS THAN 18 YEARS OF AGE:
SIGNATURE:________________________ AGE:_____________ DATE:___________
HCPaddlers ANNUAL MEMBERSHIP : $12.00 ______________
AMERICAN CANOE ASSOCIATION (optional
) - ACA membership, subscription to Paddler Magazine, and full ACA
discounts and benefits.
INDIVIDUAL: $20.00 ______________
FAMILY: $25.00 ______________
**Through a joint ACA and Hill Country Paddlers program, these prices are a reduction of $10.00 from their regular membership prices and available only
when combined with our annual renewal.
To Print: Copy/Paste onto a blank page in your Word Processor - then print
|Make Checks Payable To:
Hill Country Paddlers
P. O. Box 3951
Kerrville, Tx. 78029-3951
|FOR ADDITIONAL INFO CONTACT EITHER:
BETH HAYNIE Phone: 866-3396 e-mail email@example.com
P.O. BOX 298 - Mountain Home, Tx. 78058
- or -
PRISCILLA BAILEY Phone: 896-0935 e-mail firstname.lastname@example.org
900 Leaning Tree Kerrville, Texas 78028