RIVER WALKERS' REGISTRATION FORM

CROSSING the RAPPAHANNOCK: A PILGRIMAGE to FREEDOM

September 22, 2012

RIVER WALKERS’ REGISTRATION FORM

Name:_____________________________________________________________________

Address:_____________________________City:_____________________State:___Zip:_____

Phone:_________________Cell:___________________Email:_________________________

Age:__________ If age 12 or under, please name the adult who will be walking in the river with you (required):____________________________Relationship______________________

Address: ____________________________City:_________________State:___ Zip:_________

·   A group of about 20 will enter and exit the river at the historic Cow’s Ford on the Fauquier side and walk 1^st upstream (to simulate the original entry from the Culpeper Co. side) then turn and walk downstream (back to the point of entry) as they recreate the original crossing.

·   Normal Conditions: 90% of the recreation will be on sand bars; 100% will actually be in the water crossing very mild rapids with an average depth of 6-8 inches. The river bottom is firm and absent of holes and debris.
·   Participants are required to wear water shoes, proper boots or tennis shoes.
·   Children under the age of 12 must be accompanied by an adult.
·   All participants must preregister and sign a Waiver of Liability.
·   Participants will be accepted on a first come basis.
·   The organizers reserve the right to refuse entry to the river to anyone we feel may be at risk.
·   The organizers reserve the right to alter this portion of the program should the condition of the river be hazardous.
I, the undersigned, have read and been apprised of the potential risks and requirements should I choose to participate in the “River Walk” portion of the recreation of the Crossing to Freedom event on Saturday, September 22, 2012. 

By my signature below, I assume all personal responsibility for any occurrence as a result of my choice to participate and hold harmless all those listed as sponsors or co-sponsors of this event. If the applicant is under the age of 18, a legal guardian must sign this document.

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Print Name                  

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 Signature 

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Date