PARENT/GUARDIAN PERMISSION FORM [for paddlers under 18]
I hereby grant permission for my child, or as guardian take full responsibility for my Charge [ herein "my child" ] to participate in whitewater rafting, kayaking, canoeing, tubing, with Antietam Creek Canoe/Greg Mallet-Prevost [ACC] And I hereby agree as follows:
I fully understand and acknowledge that: (a) risks and dangers exist in my child’s use of rafting, kayaking, canoeing, tubing, equipment and my child’s participation in rafting, kayaking, canoeing, tubing, activities; (b) my child’s participation in such activities and/or use of such equipment may result in injury or illness or disability or death or damage to personal property (c) these risks and dangers may be caused by other participants, or by accidents, or by the forces of nature or other causes. Risks and dangers may arise
from foreseeable or unforeseeable causes including, but not limited to, selection of trail or river route, water level, weather conditions, risks of falling out of, from, or during a raft, kayak, canoe, tube, 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. I have been advised that my child must wear an approved personal flotation device at all times while on the water. 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 ACC activities or use of ACC equipment shall be venued in the Washington County District Court for the State of Maryland. My child is in good health. 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. Information on my child’s physical handicaps or medical problems which I feel ACC should know about will be given in writing in advance of the scheduled trip. I release and agree to indemnify and hold harmless the Releasees 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 releasees, to the fullest extent permitted by law. Furthermore, 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 OR MY CHARGE, TO PARTICIPATE IN Antietam Creek Canoe/Greg Mallet-Prevost RAFTING, KAYAKING, CANOEING, TUBING, ACTIVITIES, AND TO ASSUME AND ACCEPT ALL RISKS ASSOCIATED THEREWITH.
Group Name (if applicable) ________________________________________________
Parents/Guardian Name[s] _______________________Signature[s]_______________________Date________
Name[s] of Child/charge ___________________________________________________________
For group trips indicate the # of minor participants for whom you are responsible and for whom you give permission to participate and attach a list of those by name.
I understand and accept that I am responsible for returning all equipment rented in “as received”
condition or replace at cost. Cost of boats$400 to $1000, Life Jackets $25, Canoe Paddles $35, Kayak
Paddles yellow $125, White Black $50. tubes $40. Initial as accepted____________________
TIME ON WATER_______________EST TIME OFF_________________TAKE_OUT__________________
# PADDLERS _________________EQUIP____________________________________________________