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BIG BEND RIVER TOURS PARTICIPANT INFORMATION

NAME_________________________________________________________________

ADDRESS______________________________________________________________   

PHONE_______________________________AGE ___________   WEIGHT_________

 

Do you have any food allergies or restrictions (such as vegetarian…please be specific about what you WILL and WILL NOT eat)?

 

Do you have any medical considerations?  Please list any CONDITIONS OR MEDICATIONS you are currently taking.

 

Are you allergic to any medication?   Please list.

 

Please list any physical limitations or disabilities.

 

Are you allergic to bee or wasp stings?  If so, please bring your epi kit or benedryl.

 

 

EMERGENCY CONTACT & PARENTAL PERMISSION TO PARTICIPATE
( If participant is age 18 or younger) Permission Granted by Parent below:

Parent or Guardian signature________________________________________________

Parent / Guardian (print name)_______________________________________________

Address______________________________City____________State____Zip_________

Phone #_________________________________________________________________

Relation_________________________________________________________________

 

Big Bend River Tours
P.O. Box 317, Terlingua TX 79852
(432) 371-3033 / (800) 545-4240
Fax: (432) 371-3034 (call first)