DURHAM OUTDOOR CLUB

WAIVER AND EMERGENCY CONTACTS

Date: Type of Activity: _________________________

Distance: Location: _____________________________________________

Terrain: ___________________________________________________________________________________

Hazards: __________________________________________________________________________________

I understand that this activity could be hazardous and requires the exercise of due caution on my part. I am suitably equipped and fit enough to complete the activity and have no medical conditions that could reasonably be expected to pose a risk to me or to the group. I agree to advise the leader of any medical conditions that may require assistance (e.g. allergies, heart condition, etc.) and agree to follow directions of the leader(s) for the duration of the activity. I acknowledge that failure to abide by these conditions could put me or other members of the group at risk.

PRINT Name & phone #	Signature	PRINT Emergency Contact Person & phone #
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