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Participant Details & Waiver

We're looking forward to welcoming you to the island!

Before filling out this form, please take a few minutes to read through the travel information and island details here in our our website. It covers everything from getting to the wharf to what to expect once you're out on Whitehead.

When you're ready, this form should take about five minutes to complete. The information helps us prepare for you specifically, from meals and travel coordination to accessibility needs and safety planning.

The final section includes a short waiver that everyone completes before boarding the boat.

Last day to complete this form: June 19th
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Section 1 — Who you are

Name

Last Name

Email

Mobile Number

Section 2 — Food

Do you have any dietary restrictions or allergies?

Do you have any dietary restrictions or allergies?
A
B

Section 3 — Access & health

Are there medical conditions, medications, or health notes our staff should be aware of in case of emergency?

Are there medical conditions, medications, or health notes our staff should be aware of in case of emergency?
A
B

Emergency Contact - Name

Emergency Contact - Phone

Emergency Contact - Relationship

Section 4 — Getting There

How are you planning to travel to Emery Wharf?

How are you planning to travel to Emery Wharf?
A
B
C
D
E
F

Roughly when do you expect to arrive in the Rockland / St. George area?

Roughly when do you expect to arrive in the Rockland / St. George area?
A
B
C

Are you open to coordinating travel or sharing a ride with other participants?

Are you open to coordinating travel or sharing a ride with other participants?
A
B
C

Anything else about your travel we can help with?

Section 5 — Waiver & acknowledgment

Whitehead Light Station is operated by Pine Island Camp, Inc. on a remote island. Please read and acknowledge the following before boarding.

Medical care. At least one Whitehead Light Station staff member will have first aid training. If care more extensive than what can be provided by this staff member is required, Light Station staff will provide transportation to the mainland, from where one can reach Penobscot Bay Medical Center in Rockland, or will engage ambulance care on the mainland or emergency evacuation services if the situation warrants it. All expenses for outside medical care are the Rental Guest's responsibility.

Assumption of risk. Participants acknowledge that the Whitehead Light Station is in a remote setting, and there is a risk of serious physical injury inherent in activities in such settings.

Belongings. Pine Island Camp, Inc. is not responsible for Rental Guest's belongings or equipment while in transit or at Whitehead Light Station facilities.

Liability. Rental Guest agrees to indemnify, defend, and hold Pine Island Camp, Inc. harmless from any and all claims, damages and costs, including without limitation attorney's fees, incurred or suffered by Pine Island Camp, Inc. as a result of the Rental Guest's or the Rental Guest's family's, guests' or visitors' use and occupancy of the Station or as a result of the breach of this agreement.

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