| GRAND RIVER RAFTING COMPANY STUDENT EMERGENCY FORM & CONSENT FORM | ||
| Student's Name: | __________________________________________ | |
| OHIP Number: | __________________________________________ | |
| Medical Awareness Factors | ||
| Epi Pen | __________________________________________ | |
| Asthma | __________________________________________ | |
| Allergies | __________________________________________ | |
| Medical Alert Bracelet | __________________________________________ | |
| Other | __________________________________________
__________________________________________ __________________________________________ |
|
| (please waterproof medication & have near at hand) | ||
| Emergency Contact #1 | Name __________________________ | Phone __________________________ |
| Emergency Contact #2 | Name __________________________ | Phone __________________________ |
| Emergency Contact #3 | Name __________________________ | Phone __________________________ |
| Parental/Guardian Consent Form: | ||
| I ________________________(parent/guardian) give my consent for ___________________ (child) to attend
and participate in a Grand River Rafting Company event on __________________(day/month/year) with _________________________ (School/Scout/Exchange Group/etc). |
||
| Parent/Guardian Signature:____________________________ | ||
| Date: ________________________ | ||