PARENT/GUARDIAN PERMISSION FORM
(This form to be used for minors only-must be signed prior to going on river)

I hereby grant permission for my child(ren)_____________________ _______________________________ _____________________ to participate in whitewater rafting, kayaking,, canoeing, tubing, meals or camping at Shenandoah River Outfitters, Inc. and Shenandoah Canoe Company on (date) ______________, 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 or camping equipment and my child's participation in rafting, kayaking, canoeing, tubing, meals or camping 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 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 a raft, kayak, canoe or 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 her/his scheduled activities. Any claims or dispute arising from my child’s participation in Shenandoah River Outfitters, Inc. and Shenandoah Canoe Company activities or use of Shenandoah River Outfitters, Inc. and Shenandoah Canoe Company equipment shall be venued in the Page County Courts of the State of Virginia.

My child is in good health 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 permit the use of any photos, slides, films, or sketches of him/her taken during the days activities for publicity, advertising, promotion or other commercial purpose. 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 TO PARTICIPATE IN SHENANDOAH RIVER OUTFITTERS, INC AND SHENANDOAH CANOE COMPANY RAFTING, KAYAKING, CANOEING, TUBING, MEALS OR CAMPING ACTIVITIES, AND TO ASSUME AND ACCEPT ALL RISKS ASSOCIATED THEREWITH.

Group Name (if applicable) ________________________________________________

Parents Name (Print) _______________________________

Signature _________________________________

Street and Apt. Address: __________________________________________________

City: _______________________________________
State: _____Zip: ___________

1) child's Name: ____________________________________
Age: ____ Trip Date: ________

child's Signature: ____________________________________

2) child's Name: _____________________________________
Age: _____Trip Date: ________

child's Signature: _____________________________________

3) child's Name: _____________________________________
Age: ______ Trip Date: _______

child's Signature: _____________________________________

4) child's Name: _____________________________________
Age: ______Trip Date: ________

child's Signature: ______________________________________


DO NOT LOOSE-PLEASE GIVE COMPLETED FORM TO YOUR GROUP LEADER to be turned in day of trip