James River Basin Canoe Livery, Ltd.
1870 East Midland Trail
Lexington, Virginia 24450
540-261-7334
E-mail: Information@CanoeVirginia.com
Website: CanoeVirginia.com
Parent/Guardian Permission Form
To be filled out by parents or guardians who will not be accompanying their minor child on the canoe or kayak trip
I hereby grant permission for my child _________________________________, age ________, to participate in the canoeing and kayaking trips run by the James River Basin Canoe Livery, Ltd., hereafter the "Livery", on ________________, 200___, and I hereby agree as follows:
I fully understand and acknowledge that: (a) risks and dangers exist in my child's use of canoeing and kayaking equipment; (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 arise from foreseeable or unforeseeable causes including, but not limited to, selection of river route, water level, weather conditions, risks of falling out of a canoe 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.
I realize that this is a self-guided trip with no lifeguards or supervision on the river beyond the adults accompanying my child. I understand that rivers rise and fall and that conditions on rivers change; that boats do turn over and can be pinned on obstructions and can be damaged and /or destroyed; that people do get banged and scraped on rocks and can even drown; that trees are dangerous obstacles; that weather conditions can include hot sun or heavy rain, lightning, hail, strong winds, and cold temperatures and can change dramatically; and that my child may suffer accidents, insect or animal bites, insect stings, or illness in remote places where there are no medical facilities. I agree not to hold the Livery liable for injuries, loss of life, or damages because of such changes or conditions. I understand that all these dangers and other dangers, both seen and unforeseen, can be hazardous for even skilled paddlers. I understand all the risks involved in the use of any equipment rented or borrowed from the Livery and agree that neither it nor its agents or employees will be held liable by me or my heirs for any injuries, loss of life, or damages suffered.
I understand that the Livery has various maximum water levels and minimum water temperatures for its trips and will move my child's trip to a safer one should conditions on the scheduled trip be outside the Livery's safety standards. I also understand that my child will receive a briefing on water and canoe/kayak safety and instruction on how to handle her/his boat. I affirm that my child is mature enough to understand this orientation and will be attentive throughout. My child must wear an approved personal floatation device at all times while on the water. I further affirm that my child will not be under the influence of alcohol or controlled substances, and will not carry, use, or consume these substances before or during her/his scheduled activities. I understand that I will be responsible for the loss or damage as a result of my child's use, transport, and/or possession of equipment of any kind or description whatsoever, hired or on loan from the Livery or its employees or agents and will pay for any loss or damage as a result of my child's participation.
My child is in good health and is above the minimum age of eight years. I understand that strenuous physical exertion will be required and my child has no known physical disabilities or health problems which will present any risk in his/her participation in this activity. I have discussed all of this with my child and she/he understands the risks, requirements, and responsibilities associated with her/his participation in this activity. My child understands that it is essential to listen carefully to all instructions from the Livery's personnel and to any and all adults who will be accompanying her/him on the river.
I permit the use of any photos, slides, films, video, or sketches of her/him taken during this activity for publicity, advertising, promotion, or other commercial purposes.
This agreement shall be binding on my heirs, successors, assigns, administrators, and executors.
The venue for any claims or disputes arising from my child's participation in the James River Basin Canoe Livery, Ltd.'s activities or use of James River Basin Canoe Livery, Ltd.'s equipment shall be in the courts of Rockbridge County located in Lexington, Virginia.
I HAVE READ THE ABOVE AND BY SIGNING IT AGREE. IT IS MY INTENTION TO GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN THE JAMES RIVER BASIN CANOE LIVERY, LTD.'S CANOEING AND KAYAKING ACTIVITIES AND TO ASSUME AND ACCEPT ALL RISKS ASSOCIATED THEREWITH.
Group name (if applicable)_____________________________________________ Group leader__________________________________________
Parent or guardian's signature___________________________________________ Please print name_______________________________________
Parent or guardian's signature___________________________________________ Please print name_______________________________________
Date____________________
Street and apt. address____________________________________________________________________________________
City_________________________________________ State______________________ Zip code_______________________
Minor's signature__________________________________________ Age___________ Trip date_______________________
Minor's printed name_______________________________________
Please visit our website at "http://CanoeVirginia.com" for further information and explanations. You are also invited to contact us directly via phone or e-mail with any questions or concerns.