NVHC 2010 Membership Application

 For a copy of this form you may print the form BEFORE clicking the "Submit Form" button.

Please fill in all fields marked with a *
First Name* *
Last Name *
 *
Street * *
City *
 *
State *
 *
ZIP *
 *
Main Phone * xxx-xxx-xxxx
Emergency Phone xxx-xxx-xxxx
Email address *
 *
Membership type * Individual Membership
Family Membership
*
Family Members
List all family members other than yourself, including the names and ages of all members under 18 years of age.
Leave blank if this is an Individual Membership
Previous year member Yes
No
Comments
Do You Accept the
Liability Disclaimer *

Yes *

Liability Disclaimer:

I do hereby agree to assume all risks and liability related to or resulting from any and all Club functions. I will not hold any of the Club’s leaders, officers, or representatives liable for any injury, loss, or damage to my own person or any members of my family, children, pets, or property, arising directly or as a consequence of a hike or Club activity.

Participation of Children:

Children under 18 must be accompanied by a responsible adult. Both the child and their parent or legal guardian must sign and acknowledge the liability disclaimer on the sign-in sheet. Please call the hike leader in advance to verify that the hike is appropriate for children.