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This form is intended to make you aware of the risks associated with canoeing on The River Wye. You are aware that you enter into this activity at your own risk. We are not responsible for the conditions on the river or the physical characteristics of the terrain that may be a hazard to you. You are expected to take care and precautions whilst on the river and use your own judgment to minimise the risk to you from hazards on the river. We will provide advice on issues of safety before you start the activity. Anyone with a medical history must disclose to us any medical conditions from which they suffer (this includes but is not limited to: pregnancy, loss of immobility, heart disease, diabetes, asthma, allergy, epilepsy).

It is also intended to assist you to make an informed decision as to whether to participate. Signing this form does not (and is not intended to) limit our obligation to you and does not in any way compromise your legal rights.

Our activities by their very nature are hazardous and despite our attention to risk management there are inherent dangers involved beyond our control. As a participant with a medical history, you should be aware of and accept these risks and be responsible for your own action and involvement.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Safety & Risk Declaration
Check this box to confirm that you have read our Canoeing & The River Wye Environment page and agree to our terms and conditions.
Do you have any medical conditions that we should be made aware of?*
No
Yes

If yes, please give details below:
Do you have any allergies?*
No
Yes

If yes, please give details below:
I am confident in moving water and can swim a minimum of 25m in clothing, otherwise to be accompanied 1 to 1 with a swimmer who can, and acknowledge that this activity may involve swimming in moving water.
I understand that the activity I may participate in may expose me to many hazards and involve the risk of property damage and loss and even personal injury, illness or death. Whilst Wye Valley Canoes will take all reasonable steps to ensure my safety, I understand that they cannot be held liable for my own actions, for which I must take responsibility, or for those of a third party.
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*
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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