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Individual Membership & Renewal Form

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	Internet	From a Member	REI
How did you FIRST hear	State Park	Great Outdoor	Pied Env Center
about us?	Mast	Newspaper	YMCA

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LIABILITY WAIVER

On behalf of myself and family members (if any), we do hereby release the Piedmont Hiking & Outing Club from any and all responsibility for any injuries, accidents or damages sustained while participating in a club outing. We certify our fitness and preparation to participate in an outing, and knowingly and freely accept the risk of such participation. We understand that an outing officially begins and ends at the trailhead or similar location(s) designated by the Club; and that an outing does not include carpooling, transportation, or transit to and from an outing, and we are personally responsible for and assume all risks to us associated with an outing and travel. Further, we do release any and all hike leaders, outings coordinators, club members or visitors from responsibility for any such injuries, accidents or damages that might be sustained on an outing. We understand that in the event that any person participating in an outing should, by their own volition, decide to leave the group in any manner, they shall do so at their own risk. Neither the Club nor its members shall be responsible in any manner for such actions. We have read and understand this liability waiver, and agree that receipt by the Piedmont Hiking & Outing Club of this completed membership application form and the payment of the membership dues acknowledges acceptance of this liability waiver.

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