TRAILS CLUB OF ROSSMOOR HIKING SIGNUP FORM

Release of Liability for Personal Injury

By listing my name below I voluntarily assume all risks of personal injury, death and/or property damage that may occur to me in connection with or in any manner related to participation in hiking or other activities of the Trails Club of Rossmoor; and hereby agrees to release, indemnify and hold harmless all officers and members of said Club from any and all claims, relating to the death, injury or property damage.

Destination _______________________________________________ Date __________________

★ HIKE LEADERS: RETURN THIS SHEET TO THE WOODEN BOX AFTER HIKE IF NO INCIDENTS. 

★ CHECK BOX IF INCIDENT REPORT IS FILLED OUT. CALL PRESIDENT IF SERIOUS.  

#	Printed Name	Cell #	Driver ()	Emergency Contact #
Leader
2
3
4
5
6
7
8
9
10
11
12
13
14
15

(go to second side)

Incident Report

✦ Fill out info below, check box on the front, call the President IF a serious incident. ✦ 

Emergency  

▢ EMS took hiker to the hospital

▢ Hiker assessed by EMS but refused further treatment.

▢ Fellow hiker/family member took hiker home ▢  or to Urgent Care/hospital ▢

Brief description of illness, injury or incident:____________________________________________

Non-emergency Hiker didn’t complete the hike because:

▢ Couldn’t keep upExplain:______________________________________________

▢ Not feeling wellExplain:______________________________________________

▢ Left the hike without approval of Leader   ▢ Got lost/confused 

 ▢ Delayed hike  ▢ Had to contact Police/Park Service

▢ Volunteer escort did the following:

▢ Waited with hiker at trailhead for group to return

▢ Took hiker home

▢ Waited with hiker at safe location for pickup

Other Reportable incidents: hike impacted because…

▢ Hiker couldn’t keep up. Cause:▢  Gear▢ Not physically able▢ Illness

▢ Noticeable falling or tripping

▢ Suspected dehydration ▢ Suspected low energy due to lack of food

▢ Hiker refused to follow leader instructions and/or Club’s hiking guidelines.

Additional Comments/Concerns: (additional comments can be attached on separate sheet)

_________________________________________________________________________________________

Signature of Leader:

___________________________________________________________ Date: ________________________

Signature of Affected Hiker: (OPTIONAL) _______________________________________________________

REVISED July 10, 2025