Monthly Online Support Group Registration

Monthly Online Support Group Registration

(previously called Virtual Hike Habit - new name, same program)
Wild Grief's monthly online support meeting is on the second Saturday of every month from 11 a.m. -1 p.m. Pacific time. Feel free to sign up for as few or as many as you'd like!
(12-2 p.m. Mountain/1-3 p.m. Central/2-4 p.m. Eastern or find your local time here.)
Name*

First NameLast Name
Pronouns
Additional Family Attending
Phone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Which upcoming Hike Habits would you like to attend?

Saturday, October 14, 2023 Online Support GroupSaturday, November 11, 2023 Online Support GroupSaturday, December 9, 2023 Online Support Group
How did you hear about Hike Habit?
Emergency Information
Emergency Contact's Name

First NameLast Name
Phone Number
Below are questions that will help our funders understand who we are serving and will help us improve our programs. The answers below have no bearing on whether you will get to participate.
Please select the race/ethnicity of the participant.*

African American/BlackNative American/American Indian/Alaska NativeAsianHispanic/LatinoBiracial/MultiracialI prefer not to answer.Other
Please select the race/ethnicity of the participant (select all that apply).*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderHispanic or LatinoWhiteDecline to answerOther
Household income*

< $30,000$30,000-$50,000$50,000-$80,000>$80,000Decline to answer
What age bracket do you fall within?*

18-2526-6464+Decline to answer
Liability Release and Waiver

Acknowledgement of Participant Responsibility, Express Assumption of Risk, and Release of Liability.

In consideration of authorization to participate in a Wild Grief event, I hereby agree and acknowledge the following, including a release of liability, which will apply to this and any future Wild Grief events:

1. By signing this Waiver & Release for myself (or for the participant if the participant is under 18) I agree to WAIVE, DISCHARGE CLAIMS, RELEASE, HOLD HARMLESS, and INDEMNIFY Wild Grief, a non-profit Washington State corporation, and its officers, directors, volunteers, members, employees and agents, and any and all authorized participants for any injury, loss or damage suffered as a result of participation in any Wild Grief event, or any activity associated with said events, caused by the NEGLIGENCE of any of the above-named persons or entities. I understand that this Release is also binding on my heirs and representatives and that any legal action that may arise at any Wild Grief event will be handled in the state of Washington according to Washington State law.

2. I understand that there are certain risks associated with a Wild Grief program whether virtual or outside, either solo or in a group, including emotional stress or trauma, and the risk of serious personal injury or death, and I expressly agree to assume these risks. When undertaking a group outdoor activity, I understand the route chosen may be challenging, not necessarily the safest or easiest route, and that weather, and trail conditions may make the hike more difficult. I warrant that I am in proper physical condition to participate in this event.

3. Unless I expressly opt-out below, I give permission to Wild Grief to use my image, and voice in any future Wild Grief materials, including print or on-line, should I appear in photos or videos taken during any Wild Grief event.

4. I understand Wild Grief and all its sponsors, their respective officers, directors, volunteers, members, employees and agents are not responsible for any lost, stolen, or damaged personal property during any Wild Grief event.

5.Wild Grief reserves the right to remove a participant from a Wild Grief event if the participant is determined by an authorized Wild Grief representative to be disruptive, or is endangering themself or other participants.

6. I understand Wild Grief requires all participants to observe and comply with applicable state, city and county public health orders, laws and regulations for preventing the spread of the Coronavirus/COVID-19. I understand Wild Grief cannot be held liable for any exposure to Coronavirus/COVID-19.
I agree that I have read this liability release and waiver in its entirety and voluntarily assume all risks and obligations outlined therein.*

Yes
I would not like images or videos of me to be used by Wild Grief

By clicking this box, I opt out of images or videos of me being used by Wild Grief.
Signature of Participant

Clear
Addendum for Minor Participants

Please sign the addendum below if there are any minor's participating in this program.

Addendum to Liability Release and Waiver for minor participants

A parent or legal guardian must sign on behalf of all persons under the age of 18 participating in any Wild Grief event.

I authorize emergency medical treatment for the minor named below and I accept full responsibility for all medical expenses incurred as a result of the minor’s participation in any Wild Grief event.

I hereby WAIVE, DISCHARGE CLAIMS, RELEASE, HOLD HARMLESS, and INDEMNIFY Wild Grief and all its officers, directors, volunteers, members, employees and agents, and any and all authorized participants, from any claims made by or on behalf of the minor named below arising out of any injury, loss or damage suffered as a result of the minor’s participation in a Wild Grief event or any activity associated with it.

I further state I am a parent or legal guardian of the minor named below and am authorized and legally competent to sign this Liability Release and Waiver. I understand that the terms of this Liability Release and Waiver are contractual and not a mere recital, and I have signed this document as my own free act.
Name of Minor Participant

First NameLast Name
I agree that I have read this liability release and waiver in its entirety and voluntarily assume all risks and obligations outlined therein.

Yes
Parent/Guardian Signature

Clear
Should be Empty: