December 20th at Whitetail, one-day trip, meet to carpool.

January 23-24 Joining Mr. Piersons crew to ski and stay the night in warm, verry nice cabins and a spaghetti dinner!

February 21, last ski trip!

I hereby give (PARTICIPANT NAME) ________________________ my permission to engage in (DESCRIBE ACTIVITY) _____________________________________  and related activities with Venture Crew 1313 of Winchester, VA on  (DATE) __________________________________. With this also goes my permission to engage in any activity necessary to ensure a safe, fun, and comfortable trip. I hereby agree to not hold Venture Crew 1313, or any of it’s affiliated people, members, organizations, directors, participants, chaperones, or anything/anyone affiliated with, associated with, or related to the Venture Crew 1313 liable for any damage to my son/daughter’s person or property.

I understand that this is a very strenuous activity with exposure to high-class rapids, fast water, and severe undertow. I agree and certify that my child is physically prepared and has sufficient background and experience to undertake this event.

In the event of illness or injury occurring to my son or daughter while involved in this activity, I consent to X-ray examination, anesthesia, medical, or surgical diagnostic procedures or treatment that is considered necessary in the best judgment of the attending physician and performed by or under the supervision of a member of the medical staff of the hospital furnishing medical services. It is understood that in the event of serious illness or injury, reasonable efforts to reach me will be attempted.

I understand and agree that my child will be required to abide by all rules and regulations set forth by Crew 1313 and/or those rules, regulations and decisions of any advisor supervising the above activity. I agree to pay for all property, personal, and punitive damages incurred by the actions of my child/ward, intentional or otherwise. I understand and agree to the Crew’s no-tolerance drug and alcohol policy, and understand that my child/ward will be expelled from the Crew and may prosecuted for any violations of this policy. I understand and agree that any child who uses any alcoholic beverages, illegally drugs or engages in behavior which is deemed to be dangerous or inappropriate to the situational circumstance will be asked to return home.  In the event any child is requested to leave, I agree to make any arrangements necessary to have my child transported home and/or agree to be fully responsible for any costs necessary to have my child transported home if I am unable to personally come and retrieve my child.

Parent/ Guardian Signature _______________________________     Date  _____________

Phone numbers where I can be reached during the time of this activity:
Home: __________________________
Work: __________________________
Cell: ____________________________

Raft Trip:_______________________

Name Registered Under_________________________

Name:_______________________________________

Address:_____________________________________

City:________________________________________

State:_______________________________________

Zip:__________________ Email:___________________________

As used in the Agreement, the word “ Wildwater” means collectively, Wildwater Expeditions Unlimited, Inc. and its guides, trip leaders, officers, directors, and employees.

I fully understand that fast-moving water is dangerous and that walking on rocky or wet riverbanks is dangerous. I fully understand and accept that whitewater rafting and use of related equipment exposes me to many hazards including bodily injury and loss of my property. I fully understand that some of the hazards associated with such activities include, but are not limited to, broken bones, sprains, strains, cuts, dental and other bodily injury, death, partial and/or total paralysis, illness or other ailments that could cause serious disability, property damage, or loss of equipment. These risks and dangers may be caused by the negligence of the owners, employees, officers or agents of Wildwater, the negligence of participants, the negligence of others, accidents, breaches of contract, the forces of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to, guide decision making, including that a guide may misjudge terrain, weather, trail, or river route location, and water level, risks of falling out of or drowning while in a raft, canoe, or kayak and such risks, hazards and dangers that are integral to recreational activates that take place in a wilderness, outdoor or recreational environment.

I voluntarily choose to participate in this whitewater rafting trip in spite of these named risks and other un-named risks which are inherent in this activity and I voluntarily assume all risk of loss, damage or injury. I am solely responsible for deciding to participate in this trip.

I have read the copy of West Virginia Statue 20-3B-4, Duties and Participants, Whitewater Responsibility Act on the reverse side of this page. I agree to act in accordance with the Duties of Participants.

In consideration of Wildwater furnishing services to enable me to make a whitewater raft trip, I hereby assume all risk of injury or loss of life to myself and loss or damage to property arising out of my participation in such trip, including hazards associated with any defect in a manufacturer’s product. I specifically waive and release Wildwater from any and all liability (including, without limitation, claims based on negligence, active or passive, improper supervision, equipment failure, improper instruction or inadequate planning) as to my right of action or claim to relief that may accrue either to me or to my heirs or personal representatives for any such injury, loss of life, or loss of or damage to property which I may suffer while participating in such recreational activity, including travel to and from the river and other activities preliminary and subsequent thereto. I further hold Wildwater harmless from any and all liability, actions, causes of action, claims and demands of every kind and nature whatsoever which I now have or which may arise from or in connection with my whitewater raft trip or participation in any other activity related thereto.

I hereby grant Wildwater the right to use, including for promotional purposes, any photograph or electronic image taken of me during my participation in its recreational activities or on its properties.

IN CONSIDERATION of the participation herein above mentioned, I and my estate, personal representatives and heirs do hereby agree to INDEMNIFY and HOLD HARMLESS Wildwater from all claims, costs, judgments, losses and expenses arising out of injuries to the person, or damage to the property of the participant.

The exclusive venue of any dispute that may arise out of this agreement or otherwise between the parties to which Wildwater Expeditions Unlimited, Inc. or its agents is a party shall be Fayette County Circuit Court, Fayetteville, West Virginia.

I HAVE CAREFULLY READ THE FRONT AND BACK OF THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN OF MY OWN FREE WILL. IT IS MY INTENTION TO EXEMPT AND RELIEVE WILDWATER FROM LIABILTY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIENCE OR ANY OTHER CAUSE .

_________________¬__________ ________________ ________ ____________
Participants Signature Printed Name Date Date of Birth

___________________________ ________________ _______ ____________
Parent/Legal Guardian’s Signature Printed Name Date Date of Birth
(if under 18 years of age)

ARTICLE 38. WHITEWATER RESPONSIBILITY ACT

West Virginia Statute § 20-3B-4. Duties of participants.

(a) Participants have a duty to act as would a reasonably prudent person when engaging in recreational activities offered by commercial whitewater outfitters and commercial whitewater guides in this state.

(b) No participant may:

(1) Board or embark upon any commercial whitewater expedition when intoxicated or under the influence of nonintoxicating beer, intoxicating beverages or controlled substances; or

(2) Fail to advise the trip leader or the trip guide of any known health problems or medical disability and any prescribed medication that may be used in the treatment of such health problems during the course of the commercial whitewater expedition; or

(3) Engage in harmful conduct or willfully or negligently engage in any type of conduct which contributes to or causes injury to any person or personal property; or

(4) Perform any act which interferes with the safe running and operation of the expedition, including failure to use safety equipment provided by the commercial whitewater outfitter or failure to follow the instructions of the trip leader or trip guide in regard to the safety measures and conduct requested of the participants; or

(5) Fail to inform or notify the trip guide or trip leader of any incident or accident involving personal injury or illness experienced during the course of any commercial whitewater expedition. If such injury or illness occurs, the participant shall leave personal identification, including name and address, with the commercial whitewater outfitter’s agent or employee.

Purpose: To enable parents or guardians to authorize the provision of emergency treatment for their children who are injured or become ill while under the authority of adults, leaders or supervisors of Crew 1313 in the event the parents or guardians cannot be reached.

This acknowledges that we, the undersigned, parent(s) or legal guardian(s) of [Name of Participant] ______________________________________ recognize the potentially hazardous nature of high adventure activities and that injuries might be sustained. These injuries include, but are not limited to, PERMANENT DISABILITY, BLINDNESS, PARALYSIS AND DEATH. In the event of such an injury to my child and we (I or my spouse or guardian) cannot be contacted, we give permission to qualified and licensed EMTs, physicians, paramedics, and/or other medical or hospital personnel to render such treatment. I/we further hereby authorize the use or disclosure of my child’s/ward’s individually identifiable health information should treatment for illness or injury become necessary.

We (I) release the Boy Scouts of America, Opecon Church, Crew 1313, its employees, its agents, its volunteers and its assigns from any liability for personal injuries caused by or having any relation to high adventure activities and/or medical care. We (I) understand that this release applies to any present or future injuries or illnesses and that it binds my heirs, executors and administrators.

We (I) further assume the financial obligation for any medical care provider bills or charges, telephone calls, or other expenses relating to an emergency which are incurred.

This release form is completed and signed of our own free will and with full knowledge of its significance.

I have read and understand all of its terms.

Parent/Guardian:
______________________________________________________________________________
Name Printed Signature Date Phone

Parent/Guardian:
______________________________________________________________________________
Name Printed Signature Date Phone

Family Physician:
______________________________________________________________________________
Name Printed Address Phone

Preferred Hospital: ________________________________________________________

Child’s Medical Insurance Carrier: ______________________________________________________
Name Phone

Emergency Contact:
______________________________________________________________________________
Name Printed Address Phone

Specific facts concerning child’s medical history including allergies, medications being taken, chronic illness or other conditions which a physician should be alerted to: ______________________________________________________________________

Completed forms should be given to the adult leaders