Shuttle Request Test Shuttle Service Request Step 1 of 3 33% This field is hidden when viewing the formNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.About YouYour Name(Required) First Last Phone(Required)Email(Required) Campsite(s) Name of Campsite and Location Name of Permit Holder First & Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code LaunchLaunch Date(Required) MM slash DD slash YYYY Time Vehicle Is Ready For Pickup(Required) Hours : Minutes AM PM AM/PM Launch Location(Required)RimrockBridgeportCiscoDeltaDewey BridgeEscalanteHittle BottomLomaTakeout BeachWestwaterBlue HeronTake OutTake Out Date(Required) MM slash DD slash YYYY Take Out Time(Required) Hours : Minutes AM PM AM/PM Take Out Location(Required)WestwaterCiscoDewey BridgeHittle BottomTakeout BeachMoabEscalanteBridgeportWhitewaterRimrockKeysWhere Is The Key?(Required) Rimrock Office Rimrock Dropbox Hidden On Vehicle Other Where Is Your Key Located?(Required)Where On Your Vehicle Is The Key Hidden?(Required)Do You Have The Second Key?(Required) Yes No Do You Want Your Vehicle Locked?(Required) Yes No Keypad Code?Where Do You Want The Keys After Dropoff?(Required)Vehicle DescriptionVehicle Color(Required)Vehicle Make(Required)Vehicle Model(Required)Vehicle Year(Required)License Plate Number(Required)Issuing State(Required)Trailer?(Required) Yes No I certify that:(Required) I Agree1. The Key I have given to RRA will lock, unlock and start the described vehicle. 2. The vehicle is in safe and legal working order. 3. The vehicle has an appropriate spare tire and agree to pay additional fees if a tire change is necessary. If my vehicle or trailer becomes innoperable(Required) leave vehicle/trailer parked safely and do not repair. have vehicle/trailer towed to Rimrock Adventures. I agree to pay Rimrock Adventures any additional fees ACKNOWLEDGMENT OF RISK AND WAIVER OF LIABILITY(Required) I Agree I, the undersigned vehicle owner/agent or authorized user of vehicle, am aware that an agent or employee of Rimrock Adventures will be driving the vehicle from the specified destination (“shuttling”). I am aware that the roads in the area may be rough and poorly maintained and the roads may include danger beyond the danger beyond the control of the drivers. I acknowledge and accept that shuttling includes the following non-exhaustive list of risks and dangers to the vehicle: vehicle damage from hitting wild game, driving on rough roads, being hit by falling debris and possible chips to windshields. I understand that these risks arise from the areas mountainous roads. I understand that these dangers are from natural obstacles rather than driver error. I, voluntarily accept full responsibility for any loss, property damage, and all other damages that may be sustained by the vehicle, including without limitation loss or damage to property such as vehicle repairs of any kind. In consideration of Rimrock Adventures shuttling, I voluntarily consent to and accept all risks associated with participation. I agree to forever indemnify, defend, save, hold, harmless, discharge and release Rimrock Adventures shuttles and their agents and employees (“Releases”) from any and all liability, claims, causes of action or demands of any kind and nature whatsoever, including attorneys fees incurred by Releases, that may arise from Releases’ negligent conduct or from my own negligent or intentional conduct in connection with the vehicle to be shuttled. It is my express intent that this Acknowledgment of Risk and Waiver of Liability shall serve as a release, discharge and acceptance of risk for my heirs, estate, executor, administrator, assigns and all members of the vehicle owner’s family. If my vehicle becomes disabled or unsafe/unlawful to drive, I authorize Rimrock Adventures to act as indicated below to remedy the situation. I am responsible for all expenses associated with towing and/or repairing the vehicle.In the event Rimrock Adventures is unable to deliver the vehicle to the take-out, contact: (responsible person not on river trip) First & Last PhoneUpload a clear picture of your vehicle insurance card(Required)Max. file size: 512 MB.Signature(Required)Special Instructions