Parental / Guardian Permission Slip

Great River Rumble!


Participants under 18 years of age must be accompanied by a responsible adult while on the Great River Rumble canoe/kayak trip.Because there is a certain degree of risk involved in this canoe/kayak trip the permission of the participantís parent or legal guardian must be obtained prior to the start of the trip.


I hereby give consent for my son/daughter, ____________________________________ to participate in the Great River Rumble canoe/kayak trip. I understand and freely acknowledge that there may be dangers encountered while participating in this trip.My son/daughter and I have been told that this trip will be a strenuous and physical challenge.I understand that there are many factors that can contribute to the cause of accidents.The possibility of strong winds and rough water are only two of the many causes of accidents that could happen while participating in this type of activity.I understand that, even though the Rumble organization will take all safety precautions necessary, that accidents do happen.I understand that my child may unavoidably be involved in an accident.


I recognize that my son/daughter may require emergency medical care while engaged in this activity.I authorize the Great River Rumble representatives to secure such medical care and transportation as deemed necessary in their judgment.I assume responsibility for any of such medical and/or transportation bills incurred on behalf of my son/daughter.I fully understand that every effort will be made to contact me as soon as possible giving first priority to my son/daughterís Medical Care.


On behalf of my child, and myself I release Midwest River Expeditions, and the Great River Rumble, its officers, directors, and agents from any claim of liability, losses, costs or expenses arising from my childís participation in this canoe/kayak trip.


Further, I authorize ________________________________ (name of responsible adult on the trip) to act on my behalf, and make binding decisions as parent/guardian of my child while participating in the Great River Rumble canoe/kayak trip.


I have read this Permission Slip and understand its terms.I sign it voluntarily and with full knowledge of its significance.



Parent / Guardianís Signature: _______________________________________________


Parent / Guardian name (printed): ____________________________________________


Relationship to Minor: ________________________________ Date:________________



Medical Information: (optional)

Medical Insurance Provider:_________________________________________________


Group plan #_______________________Member ID #___________________________


Please turn in this signed permission slip when you arrive at the registration table on your first day of the trip.