Trip Agreement Form
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1
2Trip Agreement Form
Participant Information
Name:______________________________________________________ Date_of_Birth:______________________________
Address:____________________________________________________________________________________________
City:_ ____________________________ State:_ _ ____________________ Zip_Code:_________________________________
Phone_Number:_______________________________________________ Email:___________________________________
Vehicle_Make_and_Model:________________________________________ License_Plate_Number:_______________________
Have_you_ever_canoed_or_kayaked_before?_
_Yes_
_No
Have_you_ever_canoed_or_kayaked_with_Kent_State_University?_
_Yes_
_No
Emergency Contact
Name:______________________________________________________ Phone_Number:_ ___________________________
Medical Information
Allergies_
_Yes_
_No_
If_yes,_explain:_ _________________________________________
Heart_Conditions_
_Yes_
_No_
If_yes,_explain:_ _________________________________________
Medical_Conditions_
_Yes_
_No_
If_yes,_explain:_ _________________________________________
Diabetes_
_Yes_
_No_
If_yes,_explain:_ _________________________________________
Other_Medication_
_Yes_
_No_
If_yes,_explain:_ _________________________________________
Policies
Alcohol_and_drugs_are_prohibited._Service_will_be_refused_to_anyone_under_the_influence._
_I_understand
At_least_one_person_in_the_group_must_have_a_cell_phone_with_them_on_the_river.__
_I_understand
We_reserve_the_right_to_canel_any_and_all_trips_due_to_inclement_weather_or_abnormal_river_conditions._
_I_understand
Shoes_must_be_worn_at_all_times.__
_I_understand
Private_property_will_be_respected_and_will_not_be_trespassed_upon.__
_I_understand
Glass_or_styrofoam_is_not_permitted_on_or_near_the_river.__
_I_understand
We_reserve_the_right_to_inspect_any_and_all_coolers.__
_I_understand
Life_jackets_must_be_worn_at_all_times.__
_I_understand
Trash_is_to_be_placed_in_designated_recepticals_and_will_not_be_thrown_in_the_river.__
_I_understand
There_is_no_lifeguard_on_duty_and_swimming_is_done_at_my_own_risk.__
_I_understand
Customers_will_be_held_liable_for_damages_or_loss_of_any_rental_equipment.__
_I_understand
A_$10_late_arrival_fee_will_be_assess_if_not_at_the_designated_paddling_location_at_the_appointed_time.__
_I_understand
__________________________________________________________________________________________________
Signature
Date
Office Use Only
Trip_Number:__________ Canoe:_______________ Kayak:_ _____________ Departure:____________ Expected_Arrival:________
Payment_Method:_
_Online_
_Cash_
_Check_ _____
_Credit_Card_
_Coupon
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Parent category: Legal