CANOE TRIP PERMISSION SLIP
Troop 258 will be going to Morgan’s Canoe Liverylocated at 7040 Whitewater River Lane
Brookville, Indiana 47012May 21-22, 2011. The troop will be meeting at the Montgomery Presbyterian Church at 7:30AMSaturday morning. The anticipated return on Sunday is late morning or early afternoon (11:00am – 1:00pm). Your scout will call once we return to the church. The estimated cost for this trip is $45.00 which includes food, canoe rental and transportation. NOTE: In addition to this permission slip there is a Morgan Canoe Livery Waiver that must be signed as well.
1) My son ______has permission to participate on the Canoe Trip on 5/21/2011 through 5/22/2011
2) My son’s troop account has sufficient funds (approximately $45.00) to cover the cost of this outing.
Yes _____ No ______(attach check to cover the cost of the outing)
3) Has there been any change in the condition of your son’s health since his last Scouting trip?
Yes______No______If yes list change______
Is he taking medications? No______Yes______If so list ______
4) Does he have any medical conditions that the leaders need to be aware of? (allergies, infections etc. ) Please specify
______
5) During the outing I can be reached at ______If I am not available contact
______at phone # ______
6) In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the leaders in charge to secure emergency treatment for my child named above
______
Parent or guardian signature and date
MORGAN'S CANOE AND OUTDOOR
ADVENTURES - RELEASE OF LIABILITY
In consideration of being allowed to participate in anyway in the MORGAN'S CANOE AND OUTDOORCENTERS, INC program, its related events and activities, I, X______, the
undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant, including the potential for
permanent paralysis and death, and while particular skills, equipment, and personal discipline may
reduce risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH
RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or
other, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the
stated customary terms and conditions of participation. If, however, I observe any unusual significant
hazard during my presence or participation, I will remove myself from the participation and bring such
to the attention of the Company immediately; and, 4. I, for myself and on behalf of my heirs, assigns,
personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE
MORGAN'S CANOE AND OUTDOOR CENTERS, INC., their officers, officials, agents and/or employees,
other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of
premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY,
DEATH, or loss or damage to person or property associated with my presence or participation,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUPMTION OR RISK AGREEMENT,
FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTATIAL RIGHTS BY SIGNINGIT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. X
______Age:______Date signed:______
PARTICIPANTS SIGNATURE FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility
for this participant, do consent and agree to his/her release as provided above of all the
Releasees, and, for myself, my child and our heirs, assigns, and next of kin, 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 NEGLIGENCEOF THE RELEASEES, to the fullest extent permitted by law.
X ______Date signed:______
PARENT/GUARDIAN SIGNATURE, (also, print name)