2014 Great Outdoors Pursuit Registration

Team Name:     Team Captain: (must be over the age of 18)    Age:

Street Address: City:    State:    Zip Code:   

Phone Number (with area code):    Email (will not be shared):


Team Members

Name:      Age:      Relationship to Team Captain:

Name:      Age:      Relationship to Team Captain:

Name:      Age:      Relationship to Team Captain:

Name:      Age:      Relationship to Team Captain:

Name:      Age:      Relationship to Team Captain:

Name:      Age:      Relationship to Team Captain:


Check off if a member of your team is a State of Rhode Island employee who is a member of RI Great Outdoors Pursuit planning committee or who supervised an employee who served on the RI Great Outdoors Pursuit planning committee.

Check off if a member of your team has physical constraints or a medical condition that we should be aware of. Please note who has the condition and describe the constraint or condition at the bottom of this form.


How did you hear of the Great Outdoors Pursuit? (If "other" is selected, please indicate how in the box below.)

(Please choose all that apply. PC users please hold down the Control key while selecting to choose your options. Mac users hold down the Command Key.)







Consent

I have decided to participate in the Rhode Island Great Outdoors Pursuit (the “Contest”) which will call upon me to engage in various physical activities (collectively, the “Activities”). I warrant and represent to you that I am fully familiar with the Game Rules and Activities that I will be performing in connection with the Contest, have performed the same or similar Activities prior to this time, and acknowledge complete understanding of the risks involved in performing such Activities, including the risk of serious physical injury, death and/or property damage. I make this representation to you with the full understanding that you are relying on these representations.

In view of my knowledge of the Game Rules and Activities and in view of the foregoing, I hereby accept all risks attendant thereto and agree to release and hold harmless, the State of Rhode Island including the RI Department of Environmental Management (RIDEM), and their respective parent and affiliated companies/entities and their respective employees, officers, directors and agents, and any other entities and individuals in any way connected with the Contest from any liability, claims or actions of any kind for injury, death, damage (including but not limited to property damage), loss or illness that might arise out of my participation in the Activities. I assume complete responsibility for all risks and for injuries, death and/or property damage that may occur as a result of those risks, even if such injuries, death or property damage occurs in a manner that is not foreseeable at the time I sign this release.

I irrevocably consent to and authorize the use and reproduction of my image on the RIDEM website, brochures and other publications, without compensation to me, for the purposes of promoting future DEM programs. All photographs, reproductions, displays of my image used in and for the above stated purpose shall constitute the property solely and completely of the RIDEM.

I HAVE READ THIS AGREEMENT AND THE GAME RULES THOROUGHLY AND UNDERSTAND ALL TERMS AND CONDITIONS. NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS HAVE BEEN MADE TO ME THAT CHANGE, ALTER OR MODIFY ANYTHING WITHIN THIS WRITTEN AGREEMENT. MY CLICKING ON THE SUBMIT BUTTON BELOW CONSTITUTES MY ACCEPTANCE AND AGREEMENT TO ALL OF THE TERMS AND CONDITIONS SET FORTH ABOVE. BY CLICKING ON THE SUBMIT BUTTON I SIGNIFY THAT I AM OVER 18 YEARS OF AGE AND HAVE THE RIGHT TO MAKE THIS AGREEMENT ON BEHALF OF ALL TEAM MEMBERS UNDER THE AGE OF 18.