PARENT/GUARDIAN PERMISSION FORM

For Children Under 18 Years

 

READ CAREFULLY

 

I hereby grant permission for my child(ren) (1)________________________________, (2)___________________________________, and (3)_________________________________________ to participate in canoeing, kayaking, rafting, tubing, fishing, guided fishing trips, meals, camping, or any other activities at or provided by Canoe the New Outfitters, LLC on this ______ day of _______________, 200___ and I hereby agree as follows:

 

I fully understand and acknowledge that: (a) risks and dangers exist in my child’s use of rafts, kayaks, canoes, tubes, camping or other equipment and in my child’s participation in rafting, kayaking, canoeing, tubing, fishing, guided fishing trips, meals, camping or other activities; (b) my child’s participation in such activities and/or use of such equipment may result in injury or illness or death or damage to personal property (c) these risks and dangers may be caused by other participants, or by accidents, or by forces of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to, maps, videos, and/or trip descriptions that may misjudge terrain, weather, trail and/or river route location, and water levels, risks of falling out of or drowning while in a raft, canoe, tube, or kayak and such other risks, hazards and dangers that are integral to recreational activities that take place in a wilderness, outdoor or recreational environment; and (d) I hereby accept and assume these risks and dangers on behalf of my child(ren).

 

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

 

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CITY                                                        STATE                  ZIP

 

Please list any medical conditions below: