Canoe and Kayak Request Form
Personal Information
First name:
Last name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
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Indiana
Iowa
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip code:
Home phone:
Cell phone:
E-mail:
Launch Information
Date of Trip:
Launch Point:
Launch Points
Carter Park
Collins Park
Cypresswood Bridge
Dennis Johnston Park
Jesse H. Jones Park
Kuykendahl Road
Pundt Park
Riley Fuzzel Preserve
Other
If you selected "Other," please type in the launch location here:
Launch Time:
Retrieval Point:
Retrieval Points
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:
Select Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
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.