Name *

First Name

Last Name

Phone *

(###)

###

####

Do you have your own kayak? *

Yes

No

Do you prefer a long or short sleeve shirt? *

Short

Long

Is this your first time attending our annual canoe trip?

Yes

No

Waiver of Liability/Photo Release *

I understand that there are risks of injury or death or damage to property involved in my participation in such an event, that it is my responsibility to insure the safety of the equipment used and to see that it is operated properly, and that the Explore God's World, Inc. and its staff and representatives assume no responsibility for the condition of such equipment, its operations, or safety of the activities involved in this event. In consideration of the acceptance of this registration by Explore God's World, I waive and release and hold harmless Explore God's World and its staff and representatives from any and all claims of damages against Explore God's World and its staff and representatives for injury, or death or damage to property that may occur as a result of or in connection with this event and agree to pay, protect, indemnify and save against all liabilities, damages, costs, expenses, causes of action, suits, demands, judgments and claims of any nature whatsoever arising from, by reason of, or in connection with any injury or death of persons or damage to property arising from, by reason of or in connection with my participation in this event. I further understand that such an event requires all participants to be in good health and without physical limitations and I certify that I am in good health and have no physical limitations. I further warrant that my health and physical condition are sufficiently good to allow me to perform this assignment without danger to myself or to others. By clicking "Agree", you are stating that you have read the entire form above including the health acceptance of risk, waiver release, and indemnification provisions and agree to the terms therein.

Agree

Disagree