Professional Documents
Culture Documents
HAMBURG
LEESPORT
READING
PHOENIXVILLE NORRISTOWN
484-945-0200 www.schuylkillriver.org
There is no online registration. Print out these forms, and complete the REGISTRATION FORM. We will also need each participant to complete the CONFIRMATION FORM, ACA WAIVER for Adult and/or Child, CANOE SUSQUEHANNA WAIVER AND CANOE SUSQHEHANNA MEDICAL FORM. Carefully review and sign all the forms and all the waivers. and mail it to SRGA, 140 College Drive, Pottstown, PA, 19464. Your registration form and payment must be received by May 11, 2012. The sooner you register the better, because the first two days of the Sojourn fill up VERY quickly. Registration is limited and on a first-come, firstserve basis, including full-trippers. To ensure the safest possible trip, we can only accommodate 100 people on the river each day. This limit is set by our safety officers.
Pottstown: Kellys Canoe & Kayak Center 610-369-1778 Philadelphia: Philadelphia Canoe Club www.philacanoe.org Berks County: Keystone Canoe Club www.keystonecanoeclub.com
You must provide your own kayak or canoe, type 3 life vest and paddles. If renting, you are responsible for your own rental arrangements, which will include type 3 life vest(s) and paddles. Canoe or kayak rentals are available through: Doug Chapman owner of Kellys Canoe & Kayak, Gilbertsville, PA 610-369-1778, Please make sure you are registered for the Schuylkill Sojourn before making your equipment rentals. A maximum of 2 adults and one child is permitted per canoe. Special exceptions are possible at the discretion of the safety leaders.
SOjOuRn POLiCieS
No glass containers allowed on the river. ALL participants must attend the daily MAndATORY safety briefing conducted before launching. Skills instruction will be available. Participants must adhere to the safety guidelines presented. Participants must wear a USCG approved Type 3 personal flotation device (PFD) at all times. Participants under the age of 18 years are the responsibility of, and must be accompanied by, a parent or guardian. Children must be able to swim and weigh at least 40 pounds to be properly fitted with a PFD. All participants must sign a liability waiver. Parents must sign for children under 18 years of age. Directives of the Safety Officers must be followed in all situations. No pets allowed. Alcoholic beverages are not allowed on the river, in municipal parks and will not be served at Sojourn-sponsored events. Organizers and safety officers of the Schuylkill River Sojourn reserve the right to take anyone off the river who is either physically challenged by paddling, the amount of paddling required, or in a craft that does not fit or is beyond their skill level.
Every morning your gear is loaded onto a shuttle trailer, and is transported to that evenings campsite. At the end of the day, after everyone is off the river, a shuttle bus will return to that mornings launch site for people who need to move their cars. To enjoy the continuity of the trip, leave the car at home! A friend can drop you off and pick you up at the end of your trip, or take the final shuttle back to Schuylkill Haven.
SOjOuRn CHeCK-in
When you join the Sojourn, you must check-in (look for the Sojourn flag). You will receive a Sojourn sticker for your boat and your meal ticket/name tag.
CAMPinG
On-RiveR inFORMATiOn
You must provide your own camping equipment: tent, sleeping bag, drop cloth, tarp, etc. Many of the camping spots are in municipal riverfront parks with primitive facilities. We make every effort to provide you with the necessary amenities for pleasant camping. Showers are available at some stops. Cooking equipment is not allowed. At some of the campsites tents will be close together. Please be courteous of your neighbors, quiet time starts at 10 p.m. If you prefer not to camp, a list of nearby lodging is available. Alternate lodging arrangements are your responsibility. Campers, motor homes and car camping are not permitted.
During the day the safety leaders and designated safety volunteers guide the group down the Schuylkill River. The group is expected to stay together, and at times will be required to stop and wait for the entire group to move through a narrow area. Every paddler must stay in front of the last safety boat (sweep boat). Along the Schuylkill River there are portages. At these times everyone is encouraged to help other Sojourners carry their boats around the obstruction. Portage wheels are allowed as long as they fit securely and safely inside your own boat.
LATe Fee: Registrations received after May 11 will be charged a $10 late fee. CAnCeLLATiOn POLiCY: Refunds will be given, minus a $25 processing fee, if request is received by May 25. no refunds can be given after May 25 because final numbers have been given to meal and other service providers.
PRe-SOjOuRn PAddLinG
MeALS
If youve never paddled on moving water, it is recommended you receive some instruction or experience. If you need a paddling lesson or want to brush up on your skills, contact a Canoe or Kayak club in your area.
Meals are included in registration. Vegetarian meals (lacto-ovo) are available, but expect pasta and cheese dishes to accommodate vegetarian diets.
484-945-0200 www.schuylkillriver.org
Adult Day 1 Saturday Day 2 Sunday Day 3 Monday Day 4 Tuesday Day 5 Wednesday Day 6 Thursday Day 7 Friday FULL TRIP June 2 June 3 June 4 June 5 June 6 June 7 June 8 _______ x $85 _______ x $85 _______ x $85 _______ x $85 _______ x $85 _______ x $85 _______ x $75 _______ x $550
Children 15 & under _______ x $65 _______ x $65 _______ x $65 _______ x $65 _______ x $65 _______ x $65 _______ x $55 _______ x $420 SUBTOTAL
TOTALS $ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $___________
Become a Schuylkill River Heritage Area Member today for $55.00 and save 10% $____________ SRHA Members deduct 10% from SUBTOTAL only ($ ___________) TRIP GRAND TOTAL
Non-ACA members must pay an event insurance fee Adult ______ x $5 Children _______ x $5 After May 11, per person late fee $10
$___________
$ ___________ $ __________
o Charge my Visa/Mastercard
E-mail address*:
Phone eve.: Schuylkill River Greenway Assn. Phone day: 140 College Drive We must have this completed form by May 18, 2012 for you to participate in the Sojourn or your information will not be included on the Sojourn Participant List. Pottstown, PA 19464
484-945-0200
o Check here if you do not want your information on Participant List or shared with other Sojourners
* All correspondence after registration will be by e-mail, including how to download nal information & maps. If no e-mail is available, put N/A on line.
o Monday
o Tuesday
o Wednesday
o Thursday
o Friday
o I am bringing my own boat o Canoe o Kayak Length: ____________ Material: _________________________________ o I am renting a boat (you are responsible for your rental arrangement) During my evenings with the Sojourn I plan to: o Camp o Go Home/to friends house o Stay at a hotel/motel/inn
Experience Information
I rate my paddling ability on moving water as: o No experience o Beginner o Intermediate o Advanced I have certication for: o Advanced Medical Training: _____________________________________________________________ o Paddling (explain): ________________________________________________________________________________________ o Other: __________________________________________________________________________________________________ o I am willing to serve as a Safety Ofcer. (Safety Ofcer selection and need is at the discretion of Canoe Susquehanna principals). State experience: ____________________________________________________________________________________________ ___________________________________________________________________________________________________________
The information provided is for the SRGA and Canoe Susquehanna in case of an emergency
Emergency Information
Physician Name: ______________________________________________________ Physician Phone: ______________________ Health Insurance: __________________________________________ Policy #: _________________________________________
I hereby agree to abide by all rules and policies of the Schuylkill River Sojourn and recognize that I may be prohibited from activities if I fail to comply with the rules and policies. I authorize Schuylkill River Greenway Association, Canoe Susquehanna (Allan and Betsy Quant), HRO Adventures, LLC and any of the Schuylkill River Sojourn Planning Committee members to obtain emergency medical treatment for me, if necessary. I also give permission for my photograph to be taken during the Schuylkill River Sojourn activities and for the organizers of the Schuylkill River Sojourn, and Schuylkill River Greenway Association specically, to use my photographic image in commercial or noncommercial publicity for the event, for the Schuylkill River Greenway Association and for the Schuylkill River.
___________________________ Date
_______________________________________________________________________ Signature (if under 18, must have signature of parent or guardian)
If this is your rst Schuylkill River Sojourn, how did you hear about the sojourn? o Previous SR Sojourn(s) o Friends/Family o Newspaper o Web Page o Other: ____________________________________
All participants in ACA-insured activities must be ACA members in one of the following categories (choose one):
I am currently an ACA member. My member number appears below. (Check here if renewing with this form ) I would like a one-year Senior (62+) or Student Membership for $25 (under 18, or under 23 with copy of student ID) I would like a one-year ACA Paddle America Club Membership for: (check & circle one) Individual $30 | Family (2 adults + minors) $40 I would like an ACA Introductory Membership for $15 (Six month membership with benefits, including a Rapid Media magazine) I would like a one-year ACA Membership for: (check & circle one) Individual $40 | Family (2 adults + minors) $60 I would like an ACA Event Membership for $5 (one activity membership, no member benefits)
IN CONSIDERATION of being permitted to participate in any way in the American Canoe Association, Inc. sports and recreation program and related activities (Activities) I, for myself, my personal representatives, assigns, heirs, and next of kin: 1. ACKNOWLEDGE, agree, and represent that I understand the nature of paddlesports and related activities and that I am qualified, in good health, in proper physical condition to participate in such activity and willingly agree to comply with the stated and customary terms and conditions of participation. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. If I decide to leave early and not complete the trip as planned, I assume all risks inherent in my decision to leave. 2. FULLY UNDERSTAND that: (a) Paddlesports and related ACTIVITIES INVOLVE RISKS AND DANGERS OF DAMAGE TO PERSONAL PROPERTY AND SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity. 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the American Canoe Association, Inc., its Paddle America Clubs, affiliated clubs and organizational affiliates, their respective ACA certified instructors, certified instructor trainers, and certified instructor trainer educators, administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, INJURIES, DAMAGE TO PROPERTY, OR OTHER DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
Name (print) Street Address City Email Date Name / Description of Activity or Event Sponsoring Club / Organization
Rev 02/2011
Date of Birth
Zip
Activity Date
I am currently an ACA member. My member number appears below. (Check here if renewing with this form ) I would like an ACA Introductory Membership for $15 (Six month membership with benefits, including a Rapid Media magazine)
All minor participants in ACA-insured activities must be ACA members in one of the following categories (choose one):
would like a one-year Student Membership I(Under 18, or under 23 with copy of student for $25 ID) I would like an ACA Event Membership for $5 (One activity membership, no member benefits)
PARENT OR GUARDIAN: I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF PADDLESPORTS AND RELATED ACTIVITIES AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.
Parent/Guardian Name (print) P/G Street Address P/G City Date Activity Description P/G State P/G Zip Parent/Guardian ACA # (if any) P/G Phone P/G Email
MINOR WAIVER
REVISED 01/12
Release of Liability
Read before signing. Please print neatly.
Print Name
In consideration of being allowed to participate in this Canoe Susquehanna LLC program, its related events and activities, I, _________________________________________, the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of Canoe Susquehanna LLC immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Canoe Susquehanna LLC, their owners, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used for the activity (Releasees), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and, 5. I authorize Releasees to provide or obtain for me such medical care as they consider necessary and appropriate, and I agree to pay all cost associated with such care and related transportation; and, 6. I hereby give permission for my photo to be taken during activities with Canoe Susquehanna LLC and for said photographs to be used in commercial and non-commercial activity. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. _________________________________________
Participants Signature
Print Name
Age
______ ______________
Date Signed
_______________________________________________________
Address
City
State
______________
Zip Code
_______________________________________________
Email Address
Include your email address to receive a link to pictures taken on the trip!
Print Name
_________________________________________
Date Signed
______________
___________________________________ ___________________________________
LastName
FirstName
___________
Age
Height
___________
Weight
___________
Male Female
MedicalHistory
MedicalandEmergencyInformation
Markanyandallmedicalconditionsyouhaveorhavehadinthepast.
Describeallmedicalconditions(listedaboveorotherwise).
888-524-7692
Allergies
Listallknownallergies.Includefood,medication,insect,topical,andallotherallergiesyoumayhave.Ifapplicable, describethesymptomsyouexperiencewhenexposedtoeachallergenandwhenyoulasthadareaction.
www.PaddleHappy.com
Medications
Listallprescriptionandnonprescriptionmedicationsyoutake.Indicatewhyyoutakeeach,thedosageandfrequency. _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
EmergencyContacts
Listtwopeople(notonthetrip)whocouldbecontactedinthecaseofamedicalemergency.
Name