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Home Page CKAPCO WAIVER Adult Waiver Form Minor Waiver permission form

 

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There is a waiver form  below. We use it as a teaching point as well as our waiver. If you combine the Reality check page  and the What to bring page  and the About the Creek page with the Waiver you get an idea of what we want to do............... which is to very clearly establish that on the Creek, River or Any water: 1. YOU ARE RESPONSIBLE FOR YOU No one else takes over that job just because you are in a rented or borrowed boat, guide or no guide. 2. That you can be hurt, possibly die doing what YOU have chosen to do. 3. It is your judgment that determines whether or not you go on the creek or river as well as what you do on the creek or river. 4. Instructors and Guides instruct and advise and help when they safely can. They are never a substitute for your judgment. They don't make you do anything, they may not be able to solve your problems; they may not be able to protect you from harm.

 
Meritus Health 
11116 Medical Campus Road
Hagerstown, MD 21742
301-790-8000

Sheriff , Washington County 301 791 3020
State Police 301 739 2101
All Fire and Rescue 911
Boonsboro Vol.. Rescue 301 432 6979
Sharpsburg Vol.. Rescue 301 432 5348
C&O NPS  301 739 4206  or 1 866 677 6677
Antietam NPS  Visit Ctr.301 432 5124  emergency  301 432 2243

 

WAIVER AND RELEASE OF LIABILITY (please read carefully )

In consideration of Antietam Creek Canoe/Greg Mallet-Prevost [Here-in ACC/ GMP] furnishing services
and/or
equipment to enable me to participate in ACC/GMP activities, I agree as follows:
I fully understand and acknowledge that outdoor recreational activities have:
(a) inherent risks, dangers and hazards and such risks, dangers and hazards
exist in my use of ACC/GMP equipment and my participation in ACC/GMP 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, strains, fractures, partial
and/or total paralysis, death or other ailments that could cause serious disability;
c) these risks and dangers may be caused by the negligence of the owners, employees,
officers or agents of ACC/GMP; 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 raft, canoe, kayak, or tube 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 owners, agents, officers, or
employees of ACC/GMP, or by any other person. I, on behalf of myself, my personal representatives
and my heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend and
indemnify ACC/GMP, owners, agents, officers and employees from any and all claims, actions or losses
for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out
of my use of ACC/GMP equipment and,or my participation in ACC/GMP 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 owners, agents, officers or
employees of ACC/GMP. The Venue of any dispute that may arise out of this agreement or otherwise
between the parties to which ACC/GMP or its agents is a party shall be either the Circuit Court, State or
District Court in Hagerstown, MD.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE. IT IS MY INTENTION TO
EXEMPT AND RELIEVE Antietam Creek Canoe/Greg Mallet-Prevost FROM LIABILITY FOR PERSONAL
INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.


[I am over 18] .SIGNATURE/ Print name/ DATE                                                    EMAIL

 



I understand and accept that I am responsible for returning all equipment rented in “as received” condition
or replace at cost. Cost of boats$400 to $1000, Life Jackets $25, Canoe Paddles $35, Kayak Paddles
yellow $125, White Black $50. tubes $40. Initial as accepted____________________

 

PARENT/GUARDIAN PERMISSION FORM
(This form to be used for minors only)

I hereby grant permission for my child, or as guardian take full responsibility for my Charge [herein "my child"
to participate in whitewater rafting, kayaking, canoeing, tubing, with Antietam Creek Canoe And
I hereby agree as follows:

I fully understand and acknowledge that: (a) risks and dangers exist in my child’s use of rafting, kayaking,
canoeing, tubing, equipment and my child’s participation in rafting, kayaking, canoeing, tubing, 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, from, or during a raft, kayak, canoe, tube, and such
other risks, hazards and dangers that are integral to recreational activities that take place in a wilderness, outdoor
or recreational environment; and (d) I hereby accept and assume these risks and dangers.
I have been advised that my child must wear an approved personal flotation 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 ACC activities or use of ACC equipment shall be venued in the
Washington County District Court for the State of Maryland.

My child is in good health . 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 activities. Information on my child’s physical handicaps or medical problems
which I feel ACC should know about will be given in writing in advance of the scheduled
trip. 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 negligence
of the releasees, to the fullest extent permitted by law. Furthermore, The above agreement shall be binding on my
heirs, successors, 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 Antietam Creek Canoe/Greg Mallet-Prevost RAFTING, KAYAKING,
CANOEING, TUBING, ACTIVITIES, AND TO ASSUME AND ACCEPT ALL RISKS ASSOCIATED
THEREWITH.

Group Name (if applicable) ________________________________________________

Parents/Guardian Name[s] _______________________Signature[s]_______________________Date________

_______________________________________________________________________________________

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Revised: February 19, 2014.