| Date: _________________________ | Miles: ________ | Leader: _____________________________ |
Release of Liability: The St. Paul Hiking Club does not assume liability for accidents or injury. The participants of this activity, by signing this form, agree to absolve the hike leader, officers and members of the St. Paul Hiking Club of all blame for any injury, misadventure, harm, loss or inconvenience suffered by themselves or their minor guests as a result of taking part in this activity.
MEMBERS MEMBERS GUESTS
1.___________________________ 17.____________________________ 1.______________________
2.___________________________ 18.____________________________ Adr:____________________
3.___________________________ 19.____________________________ Phn:____________________
4.___________________________ 20.____________________________ 2.______________________
5.___________________________ 21.____________________________ Adr:____________________
6.___________________________ 22.____________________________ Phn:____________________
7.___________________________ 23.____________________________ 3.______________________
8.___________________________ 24.____________________________ Adr:____________________
9.___________________________ 25.____________________________ Phn:____________________
10.__________________________ 26.____________________________ 4.______________________
11.__________________________ 27.____________________________ Adr:____________________
12.__________________________ 28.____________________________ Phn:____________________
13.__________________________ 29.____________________________ 5.______________________
14.__________________________ 30.____________________________ Adr:____________________
15.__________________________ 31.____________________________ Phn:____________________
16.__________________________ 32.____________________________
Signature of Hike Leader: _________________________________________________________
Mail completed form to: Sally Nelson, 1625 Pinehurst Avenue, St. Paul, MN 55116