2019 Registration--GUESTS

Registration Form

* Indicates required field

Select Membership type. *

For Guests: Please indicate your host member (e.g. Hillary Hiker) and the hike or walk you plan to join us on (e.g. April 5, 2019). *

Name *

First

Last

Email *

Phone Number *

Cell Phone Number *

Emergency Contact Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

1. Do you have any medical conditions and/or are you under the care of a physician for any medical condition? *

No. Yes.

If yes, please explain medical conditions here. *

2. Do you have any allergies? *

No. Yes.

If yes, please explain your allergies here. *

3. Are you taking any medication? *

No. Yes.

If yes, please list medications here. *

4. Do you have any dietary restrictions? *

No. Yes.

If yes, please explain dietary restrictions here. *

5. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

No. Yes.

6. Do you feel pain in your chest when you do physical activity? *

No. Yes.

7. In the past month, have you had chest pain when you were not doing physical activity? *

No. Yes.

8. Do you lose your balance because of dizziness or do you ever lose consciousness? *

No. Yes.

9. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *

No. Yes.

10. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

No. Yes.

11. Do you know of any other reason why you should not do physical activity? *

No. Yes.

If you answered "yes" to any of Questions 5-11 please talk with your doctor about the questions you answered "yes" before you submit this registration form. You may be required to provide a written note from your doctor stating that it is safe for you to participate in hiking and walking excersizes with no restrictions.

12. You must carry medical insurance to participate. Please indicate your insurance company and policy number and/or ID # here. *

13. Choose one from the drop down menu that describes your perceived level of fitness. *

RELEASE FOR MEDIA RECORDING: I hereby consent and agree that Santa Barbara Girlfriends Adventure League (SBGAL), its board members, officers, employees, volunteers, and/or participants have the right to take photographs, videotape, or digital recordings of me and to use these in any and all media, now or hereafter known. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to SBGAL, its agents, employees, volunteers, and/or participants all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. I also understand that SBGAL is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement. *

I agree.

Your email address, name and any other information you provide, such as address and phone number you provide to SBGAL, are only used so that SBGAL can communicate with you (including adding you to SBGAL marketing lists), or in the event of an emergency, contact your designee and provide information to medical personnel as available. We do not sell or share your information. *

I agree.

I understand that my registration is not complete until I have agreed to and signed the RELEASE AND WAIVER OF LIABILITY and the SPORT PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT (print the copies in the instructions above and bring to the hike/walk you attend). *

I agree.

I agree to receiving marketing and promotional materials