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Participation Agreement
Due to the
Covid-19, we made our participation agreement virtual. Please have it filled prior your arrival to base camp. Thank you!
Participation Agreement
Between
*
Propulsion excursions en rivière inc
And
*
Name
Surname
Address
*
Address line 1
Address line 1
City
State / Province
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Email
*
Your email
Confirm your email
You are:
*
18 years old or more
17 years old or less
Reservation Number
*
Please write down reservation number given to your group. If you don’t know it, write down the organizer’s name.
Please Read Carefuly
Terms of the Agreement
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CONSIDERING: That the participant is requesting to participate in the following activity: RAFTING on the ROUGE RIVER
THE UNDERSIGNED PARTICIPANT DECLARES THE FOLLOWING:
1) The outfitter has explained, illustrated, and/or demonstrated, to my satisfaction, the nature, risks and dangers of a white water excursion and I accept them all.
2) Specifically, I understand that in the course of a river excursion, I could be thrown from the boat and fall in the water at any point on the river.
3) I am aware that the easy access of modern medical facilities is not available on the river’s direct vicinity.
4) I declare my intention to participate to this activity at my own risk and I specifically release the outfitter from any responsability regarding any loss or damages I might encounter.
5) I will, everytime, until the trip will be over, wear the provided lifejacket and the helmet fastened.
6) I also declare, due to the nature of this activity, that I am a capable swimmer in good health. I also weight at least 41 kg or 90 lb and I’m not over 136 kg or 300 lb. I confirm that I am presently not under the influence of any alcohol, drug or medication and won’t take any during the rafting activity.
7) I will follow and comply with each and all instructions given by the outfitter, his guides, instructors, or any of his employees.
8) I accept responsability for any expenses incured on my behalf or as a result of my actions.
9) I grant the outfitter the right to use for sale or publicity any pictures or videos in which I may appear without any compensation.
Things you have to bring: bathing suit, water shoes, towel and changing clothes.
I have read and understand fully the above
My weight is between 41 and 136 kg (90 and 300 pounds)
*
Yes
No
Please specify your weight (x lbs / x kg)
*
Medical Questionnaire
Medical questionnaire – Part A
*
Check boxes that apply
I am pregnant
I got a surgery in the past 12 months
NONE
Medical questionnaire – Part B
*
Did you or are you suffering of:
Heart Disease
Hypertension
Epilepsy
Hemophilia
Asthma
Psychiatric problems
Serious allergies
Diabetes
Other
NONE
Other Medical Conditions
*
Please specify any other particularity or information about your health and physical condition.
Please Read Carefuly – COVID-19
Risks Acknowledgement
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New coronavirus COVID-19, has been declared as a worldwide pandemic by the World Health Organization (WHO).
COVID-19 is extremely contagious and spreads mainly through contact in between two persons. Therefore, local, provincial and federal government autorities recommend several measures and some behaviours are prohibited, in the goal of stopping virus’ spread.
Propulsion Rafting commits itself to comply with all requirements and recommendations from Quebec Public Health and other governmental autorities, and to implement and use all measures required. This said, Propulsion Rafting cannot guaranty that you will not be infected by COVID-19. Plus, your participation to the activities could rise risk to be in contact with COVID-19, despite all measures implemented.
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By signing this document,
1) I acknowledge the highly contagious specificity of COVID-19 and assume all risks of being exposed or infected by COVID-19 though my participation to Propulsion Rafting activities. Exposition or infection with COVID-19 can cause injuries, sickness or other disorders ;
2) I hereby declare that I am participating to Propulsion Rafting’s activities on a voluntary basis;
3) I hereby declare that neither me nor anyone living in the same place than I did demonstrate any cold or influenza symptoms (including fever, cough, sore throat, breathing difficulties or disorder) in the last 14 days;
4) In the case that I that demonstrating any cold or influenza symptoms after having signed this document, I understand and agree to the fact that I will not attend any Propulsion Rafting’s activities (neither reach base camp), less than 14 days after the last cold / influenza symptom.
5) I hereby declare that neither me nor anyone living in the same place than I did travel or pass by another country, neither another canadian province in the last 14 days. In the case I would have to travel outside Quebec province after having signed this document, I understand and agree to the fact that I will not attend any Propulsion Rafting’s activities (neither reach base camp), less than 14 days after the last cold / influenza symptom.
I have read and understand fully the above, and I accept the risks.
Participant Consent
Acceptation – Participant
*
I have read and I understand and accept fully the above. I sign this agreement with free, prior and informed consent
*
Date
*
MM slash DD slash YYYY
Acceptation – Parent / Legal Guardian
You are:
*
Parent
Legal Guardian
Name
*
Name
Surname
Acceptation – Parent / Legal Guardian
*
I hereby certify that all of the above is true
*
Date
*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.
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