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ALTAMAHA
RIVER Fall Canoe Excursion
“Linda
Coleman Carson” Memorial Paddle & River Cleanup
REGISTRATION
FORM
Saturday,
September 25, 2010
Meet
at Davis Landing in Appling County at 8:00 a.m. and conclude at
Carter’s
Bight Landing in Appling County for a total of 13 miles.
Bring
your canoes, kayaks, lifejackets, sunscreen, and drinks.
A
grilled hamburger and hotdog lunch will be provided for all canoe
paddle
participants
at Carter’s Bight Landing between 12:00-1:30pm.
Only
one shuttle service will be provided to takeout point.
Shuttle
will leave promptly at 8:00a.m. from Davis Landing.
Entry:
Adults: (Pre-registration $15.00) or (Day of event $20)
*********GCA
MEMBERS GET A $10 DISCOUNT**********
&
(Children 12 years and under FREE.
Non-profit/Group
Rate of 10+ or more is $10 per person (must
be noted on application).
For
canoe and kayak rentals, call Larry Brantley at Altamaha River
Expeditions
Cell:
(912)294-3604 or email
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Bottled
water and T-shirts will be available!
Sponsored
by: Baxley-Appling County Board of Tourism
A registration
form needs to be filled out for each individual participating, even
minors accompanying parents. Please indicate # of people in canoe (2
adults & 1 child-maximum capacity), and # of canoes that will be
used. Mail registration and check to Baxley-Appling County Board of
Tourism, P.O. Box 537, Baxley, Ga. 31515 or fax to 912-367-2073. For
more information call Karen Tharpe at (912) 367-7731 or visit our web
site at www.baxley.org
Name
____________________________________________________________
Address
______________________________ City ________________________
State_____________
Zip ______________ Phone _________________________
Fax
_________________________ Age of Child______ # of Canoes _______
Group:___Yes or ___No List names that will ride together:
_________________
__________________________________________________________________
__________________________________________________________________
Email
Address:_____________________________________________________
Please
sign attached Waiver and Release of Liability and/or Parent-Guardian
Permission Form if applicable.
PARENT/GUARDIAN
PERMISSION FORM
(This
form to be used for minors only – under 18 years of age.)
I hereby grant
permission for my child
_______________________________________________________ to
participate in the Fall Canoe Paddle provided by the Baxley-Appling
County Board of Tourism on September 25, 2010.
I fully
understand and acknowledge that: (a) risks and dangers exist in my
child’s use of canoeing and kayaking, and my child’s
participation in river 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 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, including risks from native flora and fauna,; and (d)
hereby accept these risks and dangers.
I have been
advised that my child must wear an approved personal floatation
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
his/her scheduled activities. Any claims or dispute arising from my
child’s participation in the Fall Canoe Paddle or use of any
equipment provided shall be venued in the Appling County Court in the
state of Georgia.
My child is in
good health and is at or above the minimum age stated in the Fall
Canoe Paddle advertising. 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 event. I permit the use of any photos,
slides, films, or sketches of him/her taken or created during the
day’s activities for publicity, advertising, promotion or other
commercial purpose. The above agreement shall be binding on my heirs,
successor, 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 THE FALL CANOE AND KAYAKING
EVENT AND TO ASSUME AND ACCEPT ALL RISKS ASSOCIATED THEREWITH.
Group Name (if
applicable) Georgia Canoeing Association
Parents Names
_________________________________ Signature
________________________________
Street (Apt)
Address
_____________________________________________________________________
City
_________________________________________ State ___________ Zip
_____________________
Phone Number (s)
(____)
_________________________________________________________________
Child’s Name
________________________________ Age _________ Trip Date
____________________
Child’s
Signature
_______________________________________________________________________
DO
NOT LOSE – GIVE
COMPLETED FORM TO YOUR GROUP LEADER PRIOR TO PARTICIPATION
WAIVER
AND RELEASE OF LIABILITY
(Read
Carefully)
In consideration
of the Baxley-Appling County Board of Tourism (BACBT) furnishing
services and/or equipment to enable me to participate in the Fall
Canoe Paddle event, I agree as follows:
I fully
understand and acknowledge that outdoor recreational activities have
(a) inherent risks, dangers and hazards and such exists in my
participation of BACBT activities; (b) my participation in such
activities and/or use of such equipment may result in injury or
illness including but not limited to bodily injury, disease, sprains,
fractures, partial and/or total paralysis, or other ailments that
could cause serious disability or death; (c) these risks and dangers
may be caused by the negligence of the BACBT employees, officers,
agents or volunteers of BACBT; the negligence of the 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 canoe or kayak and such other
risks, hazards and dangers that are integral to recreational
activities and/or use of equipment, I hereby assume all risks and
dangers and all responsibility for any losses and/or damages, whether
caused in whole or in part by the negligence or other conduct of the
BACBT, employees, officers, agents or volunteers of the BACBT, or by
any other person.
I, on behalf of
my personal representatives, my heirs, and myself hereby voluntarily
agree to release, waive, discharge, hold harmless, defend and
indemnify BACBT and its employees, officers, agents or volunteers
from any and all claims which may arise out of my participation in
BACBT activities. I specifically understand that I am releasing,
discharging and waiving any claims or actions that I may have
presently or in the future for the negligent acts or other conduct by
the BACBT, employees officers, agents or volunteers of the
Baxley-Appling County Board of Tourism.
The venue of any
dispute that may arise out of this agreement otherwise between the
parties to which the Baxley-Appling County Board of Tourism or its
agents is a party shall be in either the Appling County Courthouse in
the City of Baxley, Appling County, Georgia, or State Supreme Court
in Atlanta, Ga.
I HAVE READ THE
ABOVE WAIVER AND RELEASE, AND BY SIGNING IT AGREE. IT IS MY INTENTION
TO EXEMPT AND RELIEVE THE BAXLEY-APPLING COUNTY BOARD OF TOURISM ITS
BOARD MEMBERS, EMPLOYEES, AND ITS VOLUNTEERS OR AGENTS FROM LIABILITY
FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY
NEGLIGENCE OR ANY OTHER CAUSE.
Signature___________________________________
Age____________ Date_______________________
Print
Name_____________________________________ Group
Name_____________________________
Street (&
Apt) Address
___________________________________________________________________
City
___________________________________________ State______________ Zip
_________________
Phone: H
(____)____________________________ W (_____)
__________________________________
Emergency contact
name ________________________________ Relationship
______________________
Phone (____)
___________________________ Date of event
_____________________________
My
canoeing/kayaking experience is: ____ Never been in a canoe or kayak
____ Beginning (check one)
____ 1 to 2+
years paddling ____ 3+ to 10+ years paddling ____ Expert
Please list any
medical problems here: (HPB: high blood pressure; ALL: allergies
(what); HRT: heart; RES: respiratory; OTH:
other)________________________________________________________________________
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