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Canoe, Kayak, and Tube Waiver and Release of Liability

Please fill out a separate waiver for each person in your party

September 21, 2025

Read Carefully

In consideration of Adirondack Fishing Adventures, Inc. doing business as Beaver Brook Outfitters (and hereinafter referred to as Beaver Brook Outfitters) furnishing services and/or equipment to enable me to participate in Canoeing and Kayaking, I agree as follows:

I fully understand, acknowledge and agree that outdoor recreational activities have: (a) inherent risks, dangers, and hazards and such exists in my use of Canoeing and Kayaking equipment and my participation in Canoeing and Kayaking 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 owners, employees, officers, or agents of Beaver Brook Outfitters; 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, 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 and agree to remove myself from participation and bring such removal to the attention of Beaver Brook Outfitters; and (d) by my participation in these activities and/or use of equipment, I hereby knowingly and freely 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 Beaver Brook Outfitters, 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 Beaver Brook Outfitters and its 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 Canoeing and Kayaking equipment or my participation in Canoeing and Kayaking 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 conduct by the owners, agents, officers, or employees of Beaver Brook Outfitters.

The venue of any dispute that may arise out of this agreement or otherwise between the parties to which Beaver Brook Outfitters or its agents is a party shall be either the Town of Johnsburg, New York State Justice Court or State Supreme Court in Warren County.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE.  IT IS MY INTENTION TO EXEMPT AND RELIEVE BEAVER BROOK OUTFITTERS FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR OTHER CAUSE.



First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information

Providing Us With Medical Information Is Voluntary And This Information May Be Accessible To Others

Do you presently have, or have you ever had any of the following:

Diabetes*
No
Yes
Heart Disease*
No
Yes
Asthma*
No
Yes
Epilepsy*
No
Yes
High/Low Blood Pressure*
No
Yes
Allergies (Bee stings, food, etc.)*
No
Yes
If yes to any of the above, do you carry medication and what type?

IF YES TO ALLERGIES, PLEASE MAKE SURE YOU BRING YOUR OWN KIT


Has your physical activity been restricted or altered during the last 5 years?*
No
Yes
If yes, give the reason why.
Have you had any recent significant illness or injury or been hospitalized other than already noted?*
No
Yes
Are you presently on any medication other than already noted?*
No
Yes
If yes, please explain.
Additional Information/Comments
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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