CONTACT & TRIP WAIVER

Benaiah Downeast Guiding Services

1123 RTE 193 Deblois, ME 04622

207-598-7545 jon@independenceelectric4me.com

CONTACT & TRIP WAIVER

Benaiah Downeast Guiding Services

1123 RTE 193 Deblois, ME 04622 207-598-7545

jon@independenceelectric4me.com

*REQUIRED WAIVER FORM

Participant Information

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Day

Year

Email

Mailing Address

Billing Address

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Emergency Contact

(Name/Relationship/Phone)

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Health & Medical

CURRENT MEDICATIONS

NONE

MY MEDICATIONS

Mobility or Physical Concerns

NONE

Mobility or Physical Concerns

I CARRY AN EPIPEN

YES

NO

I CARRY AN INHALER

YES

NO

Trip Interests & Experience

TRIP TYPE

Canoe/Kayak/PDL Kayak Fishing

Ice Fishing

Hiking

Wildlife Viewing

TARGET SPECIES

Cold Water (Trout, Salmon, Splake)

Warm Water (Small Mouth Bass, Chain Pickerel, & Yellow Perch)

Other

Benaiah Downeast Adventure Packages

I AM INTERESTED IN THE FOLLOWING ADVENTURES

EXPERIENCE LEVEL

Beginner

Intermediate

Expert

Additional Background Experience

DO YOU HAVE A VALID MAINE FISHING LICENSE?

YES

NO

Waiver of Liability & Release

I, the undersigned, understand that outdoor activities such as canoeing, kayaking, hiking, and ice fishing in remote locations involve inherent risks, including but not limited to: unpredictable weather, water hazards, encounters with wildlife, and delayed medical response due to the remote nature of the terrain.

Assumption of Risk
Physical Fitness certification
Release of liability for Benaiah Downeast Guiding Services & Jonathan Gay

MEDIA RELEASE

I grant permission for photos

I do not grant permission for photos

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Parent/Guardian signature required if participant is under 18

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CONTACT US TO BOOK YOUR TRIP