Black Elk Peak Hiking Form

Who: Middle School Students (who just completed grades 6-8)
When: June 29, 7:00am. Returning the same evening.
Where: Black Elk Peak Trail #9 near Custer, South Dakota. 6 miles round trip. Manageable incline. Wide & heavily used trail.
What to Bring: Bring a small backpack with a pack lunch and some water. Shorts and tennis shoes are fine on this trail. We'll have lunch at the summit and plan to get some food on the way back. Please--no energy drinks.

Name of Student

Grade Level Just Completed

Does the participant require a special diet, have allergies, or any other medical related issues?

Please identify any limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity.

Do you plan to bring a friend? If so, how many?

I understand the physical demands of the activity and confirm I am in suitable health to participate.

I agree

I acknowledge that hiking and walking activities involve risks, including but not limited to slips, trips, falls, and environmental hazards. I agree to follow all safety guidelines and instructions provided by the organizers.

I agree

I release the non-profit group from any liability for injuries or damages that may occur during the activity.

I agree

Primary Guardian/Contact Name

Primary Guardian/Contact Phone

Primary Guardian/Contact Address

Secondary Emergency Contact Name

Secondary Emergency Contact Address

Secondary Emergency Contact Phone

Enter Name Here to Sign:

Description

May 29

Please fill out this form and click submit. Thanks!

Black Elk Peak Hiking Form

Description

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