Date: _________________	Nbr. members    _______
Hike Title: __________________________________________	Nbr. guests         _______
Mileage: ___________ Location:_________________________	Nbr. children      _______
	Total   _______

Mail completed form to: Ellen Mutzl, 8942 Stonewick Way, Zionsville, IN 46077

Release of Liability: The Indianapolis 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 Indianapolis 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.__________________________ CHILDREN UNDER 18
I attest that I have read aloud or explained the liability release:                      _____________________

Signature of Hike Leader: ____________________________                     ____________________