PARENT/GUARDIAN
PERMISSION FORM
For Children
Under 18 Years
READ
CAREFULLY
I hereby grant permission
for my child(ren) (1)________________________________,
______ day of _______________, 20___ and I hereby
agree as follows:
I agree that my child(ren)
will comply with all federal, state, and local pollution, water, camping, and
fire regulations including any emergency orders from the aforementioned. I
agree that my child will not to litter, trespass, abuse property, or in any way
infringe upon the rights of other river users. I understand Canoe the New and
its employees cooperate fully with law enforcement agencies and landowners and
will not shield anyone in my child(ren)’s group from arrest and/or prosecution
for any unlawful act. I understand that the consumption of alcoholic beverages
is unsafe during any type of water activity and that Canoe the New will refuse
its services to intoxicated persons at any time during the trip or shuttle, to
or from the river, with NO REFUNDS made.
I understand that no
refunds will be made due to any stream structures or weather or river
conditions as found or changed at any time whatsoever. I understand that the shuttle
service is given to my child(ren) free when I rent the boat and when they
perform in accordance with this contract and any other instructions given them.
Failure to do so will result in no shuttle. They will aid in the loading and
unloading of all their personal and rented equipment and carrying it to and
from the river. I understand that put-in and take-out times are mutually set
and must be coordinated with other people and groups. I understand that my
child(ren)’s failure to meet their pickup time will move them to the “back of
the line” and mean a delay in their return shuttle.
My child is in good health
and is at or above the minimum age stated in Canoe the New, LLC advertising and
policies for each activity in which he/she will participate. I understand that
strenuous physical exertion may be required and my child has no known physical
disabilities or health problems, which will present any risk to his/her
participation in the activities. I HAVE NOTIFIED Canoe the New Outfitters, LLC
OF ALL MEDICAL CONDITIONS THAT MAY PRESENT A RISK TO HIM/HER OR OTHER
PARTICIPANTS THROUGH HIS/HER PARTICIPATION IN THESE ACTIVITIES AND HAVE NOTED
SUCH CONDITIONS ON THE BACK OF THIS FORM. I release and agree to indemnify and
hold harmless the Releases from any and all liabilities incident to my minor
child’s involvement or participation in these programs as provided above, EVEN
IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted
by law.
In consideration of the
obligations hereinafter set forth, I hereby assume all legal and monetary
responsibilities and risk for all property hired or on loan from Canoe the
Outfitters, LLC, hereinafter “Canoe the New,” its employees, or agents, as a
result of our use, transport, and/or possession of equipment of any kind or
description whatsoever.
I hereby agree to return
all equipment at the mutually set time, date, and location in the same
condition as when received by my child(ren). All unreturned or abandoned items
will be considered lost and paid for at that time. I further agree that the
boat will be taken only on the waters agreed to prior to the trip and will pay
$100.00 for each run on unauthorized water or water not a specified part of my
child(ren)’s trip in addition to any damage or recovery fees that may ensue.
I have been advised that
my child must wear an approved personal flotation device (PFD) at all times
while on the water and will not be sat or knelt on. Paddles will be used only
to paddle the boat and not for poling, pushing, or prying the boat off rocks or
obstructions. The boat will not be dragged at anytime. I affirm that my child
will not be under the influence of alcohol or controlled substance, and will
not carry, use, or consume these substances before or during his/her scheduled activities.
Any claims or dispute arising from my child’s participation in Canoe the New
Outfitters, LLC activities or use of Canoe the New Outfitters, LLC equipment
shall be venued in Giles County Court of the State of Virginia.
I agree to report all
damaged or lost items immediately at the end of my child’s trip and pay for
them at that time, plus any collection or attorney’s fees that the Canoe the
New incurs through my failure to do so, according to the following schedule:
|
Boat damaged beyond repair (includes during
recovery), lost, stolen, abandoned, or otherwise not returned to the pickup
point |
$750.00 per canoe $500.00 per single-seat kayak $700.00 per two-seat kayak |
|
Damage due to dragging the boat at any time |
$50.00 |
|
Broken or lost thwart (includes during
recovery) |
$25.00 |
|
Broken or lost seat (includes during
recovery) |
$40.00 |
|
Broken or lost gunwale (includes during
recovery) |
$95.00 |
|
Hull torn or punctured (includes during
recovery) |
$20.00 per inch |
|
Hull crushed or wrinkled (includes during
recovery) |
$50.00 |
|
Broken or lost end cap (includes during
recovery) |
$30.00 |
|
Paddle lost, broken, bent, or unreturned |
$25.00 single blade $50.00 double blade |
|
Life jacket lost or damaged, hooked by lure,
sat or knelt on, or unreturned |
$35.00 |
|
Boat recovery (when possible and convenient) |
$30.00/man hour, $50.00 min. |
|
Pickups after 6:00 pm |
$20.00 per boat |
|
Late Fee for Returning Equipment (boats,
paddles, etc.) |
$20/half hour, $40.00 min. |
|
Other items: |
I permit the use of any photos, slides, films, or sketches of my child(ren) taken during the day’s activities for publicity, advertising, promotion or other commercial purposes. The above agreement shall be binding on my heirs, successors, assigns, administrators and executors.
I HAVE READ THE ABOVE AND BY SIGNING IT AGREE. IT IS MY INTENTION TO GRANT PERMISSION FOR MY CHILD(REN) TO PARTICIPATE IN CANOE THE NEW OUTFITTERS, LLC RAFTING, KAYAKING, CANOEING, TUBING, FISHING, GUIDED FISHING TRIPS, MEALS, CAMPING OR OTHER ACTIVITIES, AND TO ASSUME AND ACCEPT ALL RISKS ASSOCIATED THEREWITH.
_______________________________________ ______________________________________
GROUP NAME (if applicable) EMERGENCY CONTACT PERSON
______________________________________________ _____________________________________________
NAME OF PARENT OR LEGAL GUARDIAN (Printed) RELATION TO MINOR
______________________________________________ _____________________________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN PHONE NUMBER
______________________________________________ _____________________________________________
STREET ADDRESS ALTERNATE PHONE NUMBER
______________________________________________
CITY STATE ZIP
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Please list any medical conditions below: