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Medical Form & Waiver

Medical Form

Your Contact Information

Name
Address
(if applicable)
Friends/Family on the tour and their relationship to you
Name
Relationship
 

Contact Person In Case Of Emergency

Emergency contact name
Emergency contact address
(if applicable)

Travel/Medical Insurance Details

Personal Information

Date of birth
Sex
Please Specify Units (cm/inches)
Please Specify Units (kg/lbs)
1 - Not Active234567 - Olympic Class

Outdoor Experience

None1-4 days5-10 days10+ days
None1-4 days5-10 days10+ days
None1-4 days5-10 days10+ days
Can't swim12345
(ie Diving, Sailing)
(ie Camping, Hiking)
Do You Have A Prefrence for a single or double kayak
(Note that we use a combination of doubles and singles for safety reasons and will often make the decisions as to which kayak best suits each person. We cannot always guarantee your request but we will try our best to accommodate you).

Health

(Please provide as much detail as possible in regards to any medical conditions or health or physical concerns that you have .)
Do you have any personal concerns (e.g. fear of water, seasickness, physical limitations etc.)?
Do you have any injuries or medical conditions that may be irritated by kayaking?
Known allergies or sensitivities: (anaphylactic to bees, wasps, food, etc)
Do you carry an Epi-pen and/or antihistamines?
(if your allergies are severe you should have one)
Is your tetanus inoculation current?
(Booster shots should be received every 10 years)
Most recent date of tetanus inoculation
Do you wear glasses?
(make sure you have straps)
Do you wear a hearing aid?
Are you currently taking any medications?
If you are bringing medication please ensure that:
  1. The name and expiry date of drug is on container
  2. You have the detailed instructions of dosage and
  3. frequency.
  4. Pack in water and sun proof container.

Dietary

We make our best effort to cater to those with food allergies and special diets. Please note that for those with severe allergies we cannot guarantee that our kitchen will be 100% trace free of the item you are allergic to. We can accommodate diets such as vegetarian, vegan, non-seafood, wheat free, and dairy but may not be able to accommodate other special diets where you are on a strict menu plan. You may want to bring some of your own snacks. Feel free to call us if you have any concerns.
Do you eat FISH?

Do you follow a VEGETARIAN diet?

Do you eat OTHER SEAFOOD?

Do you follow a VEGAN (no meat or dairy) diet?

Release and Waiver

RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND ASSUMPTION OF RISKS AGREEMENT

BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO CLAIM COMPENSATION OR SUE SHOULD YOU BE INJURED.

PLEASE READ CAREFULLY! PRINT NAME & INITIAL

TO GO WITH THE FLOW ADVENTURES and its directors, managers, officers, employees, volunteers, agents, representatives, contractors, subcontractors, the owners of facilities where Activities are held, successors and assigns (hereinafter collectively referred to as “the Releasees”).

DEFINITION This agreement shall apply to all activities, events or services provided, arranged, organized, sponsored or authorized by the Releasees, including but not limited to: kayaking, boating, camping, hiking, meals, instructional sessions, swimming, loading and unloading of boats, transportation or travel to and from locations used for the Activities by plane, motorized boat or vehicle; (hereinafter referred to as “the Activities”).

ACKNOWLEDGEMENT – SAFETY I acknowledge that the risk of injury from the Activities is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury and death does exist. I acknowledge that I have been advised to wear a personal flotation device at all times while in a kayak or in a boat.

ASSUMPTION OF RISKS I am aware that participation in the Activities involves risks, dangers and hazards including, but not limited to: injuries or loss caused while lifting, boarding, disembarking or travelling in the kayak, motorized boat, vehicle or plane; overturning of the kayak or boat; hypothermia due to exposure to very cold water; drowning; variation in the water conditions, surfaces and currents, including high waves and tides; changing and inclement weather conditions including storms, high wind and lightning; collision with rocks, trees, logs, deadfall, boating equipment and other kayaks or motorized boats; equipment failure; accidents that occur while hiking and camping including on steep slopes in their natural state that may contain many obstacles and hazards, and on terrain that may not have been travelled or climbed before and is not regularly patrolled or inspected; variation in the terrain including holes, depressions, loose gravel, rocks, mud, roots, seaweed, algae, barnacles, forest deadfall, rocks, or other natural or man-made objects on or adjacent to the trails; allergic reactions due to food cross contamination; drinking contaminated water; integrity of man-made structures including tent platforms, benches, tables, toilets; inability to obtain emergency medical assistance due to remoteness of locations; encounters with wild and domestic animals, becoming lost or separated from one’s guide, or party; failure to act safely or within one’s ability or to stay within designated areas; and negligence of other persons, including other participants of the Activities.

I AM AWARE THAT ONE OF THE RISKS, DANGERS AND HAZARDS OF THE ACTIVITIES IS NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF THE ACTIVITIES, SOME OF WHICH ARE REFERRED TO ABOVE. I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.

ADDRESS OF PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of the Releasees allowing me to participate in the Activities and permitting my use of their equipment, if any, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows:

TO WAIVE ALL CLAIMS that I have or may in the future have against the Releasees and TO RELEASE THE RELEASEES FROM ANY AND ALL LIABILITY for any loss, damage, expense or injury including death, that I may suffer, or that my next of kin may suffer as a result of my participation in the Activities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, R.S.B.C. 1996, C.337, ON THE PART OF THE RELEASEES AND INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE.

TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any property damage or personal injury to any third party resulting from my participation in the Activities.

This Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity. This Agreement and any rights, duties and obligations as between the parties to this agreement shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia and no other jurisdiction.

Any litigation involving the parties to this Agreement shall be brought solely within the Province of British Columbia and shall be within the exclusive jurisdiction of the Courts of the Province of British Columbia.

To be responsible for any injuries, damage or loss caused as a result of the use of my own equipment, including but not limited to stoves, tents, kayaks, etc.

I am responsible for all costs of rescue or medical attention rendered to me, or for my benefit, arising from the Activities and I indemnify and hold harmless the Releasees from any and all liability in respect of any and all such costs.

MARINE LIABILITY ACT The Marine Liability Act, S.C. 2001, c. 6, may limit the liability of the Releasees in the event of an accident resulting in injury or death.

In entering into this Agreement, I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of the Activities, other than what is set forth in this Agreement.

I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT PRIOR TO SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

Name of participant(Required)
Reset signature Signature locked. Reset to sign again
Date Signed(Required)

If Participant is under the age of 19, or under the age of responsibility elsewhere

Name of Parent or Gaurdian
Reset signature Signature locked. Reset to sign again
Date

“Rated Excellent”

5-star-rating
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Contact

1-888-435-2925

PO Box 706, Quathiaski Cove, BC
V0P 1N0, Canada

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