Participant Information

Full Name Date of Birth Address Phone Number Email

Emergency Contact

Full Name Phone Number Relationship

Acknowledgement and Assumption of Risk

I acknowledge that white water rafting involves inherent risks, dangers, and hazards which may result in personal injury, illness, or death. I assume all these risks voluntarily.

I have read and understand the risks involved.

Medical Information

Medical Conditions or Allergies Current Medications

Release of Liability

I hereby release and hold harmless the company, its employees, agents, and affiliates from any and all liability for injuries or damages resulting from participation.

I have read and agree to the release of liability.

Signature

Participant Signature Date

Parent/Guardian Consent (If under 18)

Parent/Guardian Name Parent/Guardian Signature Date