Walton Senior Youth Tube-a-palooza Kick-off Event

Saturday, September 6th from 10am-8pm $20

Name:                                                                Age:

Address:

Parent/Emergency Contact Info:

Any Medical Conditions/Allergies we need to be aware of?:

Do you own a lifejacket and/or bike helmet? If so, which? (this impacts how much you have to pay)

Permission Form (mandatory in order to participate):

I, the parent/legal guardian of ___________________________________ give permission for my child(ren) to participate in the Walton Senior Youth Tube-a-Palooza Kick-Off Event. I understand that there is an inherent risk in taking an inner tube down a river. I will not hold Walton Memorial United Church, it's staff, or volunteers responsible should an accident occur in which my child is injured. I also give the leaders permission to make medical decisions for my child in case I cannot be reached.

Signed:

Dated: