Live like Muhammad Camping Trip Registration Main

Registrant's Name(Must be 18 or Older to Register)*

First NameLast Name

Phone Number*

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Email Address*

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Please list any Medical Conditions(include current medications) , Allergies, and/or Dietary Restrictions or Special Accommodations *

Will you need bus transportation?*

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Do You Have a Current Drivers License?

YESNO

Do You Have a Current Fishing License?

YESNO

Do You Have a Current Hunting License?

YESNO

Do you Plan on Visiting the Following Local Attractions? Check All that Apply

Calloway GardensPresident's HouseWarm SpringsNone

Emergency Contact 1 Name*

First NameLast Name

Emergency Contact 1 Phone Number*

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Emergency Contact 2 Name

First NameLast Name

Emergency Contact 2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

LIABILITY WAIVER AND RELEASE OF LIABILITY

Trip Location: F.D. Roosevelt State Park, Pine Mountain, GA

Dates: April 10–12, 3026

1. ACKNOWLEDGMENT OF RISKS:

I understand that participating in a camping trip at F.D. Roosevelt State Park involves inherent risks, including but not limited to:

Physical exertion and potential for injury on uneven terrain (e.g., the Pine Mountain Trail).

Exposure to outdoor elements, including unpredictable weather, heat, and storms.

Encounters with local wildlife, including insects, reptiles, and mammals.

Risks associated with campfires, outdoor cooking, and use of camping equipment.

2. RELEASE AND WAIVER OF LIABILITY:

In consideration of being permitted to participate in this trip, I hereby release, waive, and discharge the trip organizers and fellow participants from any and all liability, claims, or demands for personal injury, property damage, or death arising out of or related to my participation, except in cases of gross negligence.

3. INDEMNIFICATION:

I agree to indemnify and hold harmless the organizers from any loss, liability, damage, or costs they may incur due to my participation in the trip, whether caused by my own actions or otherwise.

4. MEDICAL CONSENT:

I hereby authorize the trip organizers to seek emergency medical treatment on my behalf if I am injured or become ill and am unable to provide consent. I acknowledge that I am solely responsible for all costs related to such medical treatment or transportation.

5. COMPLIANCE WITH PARK RULES:

I agree to follow all Georgia State Park Rules and Regulations, including those regarding fire safety, waste disposal, and quiet hours (10 p.m. to 7 a.m.). I understand that I am responsible for any fines or damages resulting from my failure to comply with these rules.

6. PARTICIPANT ACKNOWLEDGMENT:

I have read this waiver in its entirety and fully understand its terms. I am signing it freely and voluntarily.

By participating in this trip, I acknowledge and accept the risks involved and agree that the organizers are not responsible for any injury, loss, or damage that may occur during the event and by submitting this form I also agree to the terms of this waiver.

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