Canoe and Kayak Request Form
Personal Information
First name:
 
Last name:
 
Address:
 
City:
 
State:
Zip code:
 
Home phone:
Cell phone:
E-mail:
 
Launch Information
Date of Trip:
 
Launch Point:
 

If you selected "Other," please type in the launch location here:
Launch Time:

Retrieval Point:
  

If you selected "Other," please type in the launch location here:
Estimated Retrieval Time:

Number of Canoes/Kayaks:
 
Number of People:
 
Emergency Information
Name:
 
Relationship:
 
Contact Phone1:
Contact Phone2:
Vehicle Information
Year:
 
Make/Model:
 
Color:
 
License Plate #:
 
Comments:
 
Acknowledgement:
By checking "Yes" at this point, I am acknowledging that I have read and understand all of the rules and regulations of canoeing/kayaking within Harris County Precinct 4. Additionally, I agree to release, indemnity and hold harmless Harris County, its officers, volunteers, agents and employees from all claims of any kind, character, type or description arising out of my use of Precinct 4 launch and/or retreival locations. Reservation forms will not be accepted without affirmation of acknowledgement.