2022-05-20 Shenandoah River Rafting Campout

Informed Consent, Release Agreement, and Authorization


Activity: Shenandoah River Rafting, or Canoeing, or Kayaking
Date: May 20-22, 2022


Troop 51 will be camping and rafting, canoeing, or kayaking on the South Fork of the Shenandoah. We will be camping at established campsites and renting watercraft from Shenandoah River Outfitters near Luray, VA. We will depart on Friday, May 20 at 5:00 PM from the upper parking lot of Floris United Methodist Church. Please assemble at the FUMC upper lot at 4:30 PM. We will return Sunday, May 22 to Floris Elementary around 10:00 AM unless drivers return Scouts to their homes. Activities on the trip will include: camping, rafting (or canoeing or kayaking), hiking, and pioneering. Pets are allowed. Siblings younger than 11 years old are allowed, but must be accompanied by a parent. Watercraft participants must be Swimmers (passed or easily able to pass the BSA Swim Test) or else be accompanied by a parent.


Transportation will include carpooling that will be organized at assembly (or as arranged between families) and driving by private car. Scouts should wear Class A uniform while traveling.


All participants (Scouts and adults) should bring the 10 essentials, personal camping gear, water shoes, and clothing appropriate for water activities and the weather. The Patrol Method will be used throughout the campout, including tenting plans and cooking. Use of Scout’s electronic devices during the event for a Scouting purpose MUST be approved by the Scoutmaster. Cell coverage may be weak or spotty. A current (within the last 12 months) BSA health & medical record (Part B) must be turned in to the event lead at assembly and will be returned at the campout's conclusion. All adults attending must have completed BSA Youth Protection Training (YPT).


The campsite is "Camp Outback" at Shenandoah River Outfitters, located at 6502 S Page Valley Road, Luray VA 22835. Potable water and restrooms are available.


The rafting trip can be either three or five hours and the longer route goes through Compton’s Rapid for a little wave action. Rafting is a little faster than tubing but 1/3 slower than canoeing. The water levels and trip length determine the time on the river. Canoeing and kayaking are upriver from rafting portion and take approximately three hours to travel eight miles. A shorter option is about three miles, which should take closer to one hour. Trips are unguided, parent volunteers will be needed for each activity type. Shenandoah River Outfitters has designated drop-off and pick-up points. For more information, see https://shenandoah-river.com/


Camping fee: $20 per person (adult or scout or sibling). Grub fee: Free for Scouts (covered by Mulch fund) and $30 per person for adults and siblings. Rafting, canoeing, or kayaking also has a fee of $28 or $30. Registration and payments are due by May 11th and will be nonrefundable after May 13. 


Emergency Contacts during the trip: Mr. Mark Christoffersen, 571-685-3395, or Mr. Todd Jackson, 571-213-2433.

Section 1 - Main Participant

Section 2 - Additional Participants

In addition to the main participant

Section 3 - Additional Contact Information

Section 4 - Medical Information

Section 5 - Consent

I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct. I understand that COVID-19 is also a risk, particularly when gathering in groups; have received Troop guidance pertaining to gathering safely and agree to comply; and acknowledge that “Safe” is NOT the same as “Risk-Free.”

I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information with any BSA volunteers or professionals who need to know of medical conditions that may require special consideration in conducting Scouting activities.

With appreciation of the dangers and risks associated with programs and activities including preparations for and transportation to and from the activity, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity.

In case of an emergency involving my child, I understand that efforts will be made to contact me. In the event I cannot be reached, permission is hereby given to the medical provider to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge and/or any physician or health care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.

Troop 51 cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. However, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below and counsel your child to comply with those restrictions.

Section 6 - Payment

$ 0.00