Please return this form to the Berome Management Board at


Scanned, signed versions may also be returned via email to  



PLEASE NOTE: This form is two pages and both must be returned after approval, EVEN IF NO TRIP IS TAKEN. Thank you.


TRIP REPORTS ARE DUE 14 DAYS AFTER THE TRIP DATE EXCEPT FOR EXTREME AND UNUSUAL CIRCUMSTANCES. We collect this data to help in management of the cave, and you are an integral part of that process.

KNOW ALL MEN BY THESE PRESENTS, That he/she who sign this document for and in consideration of a grant of permission to engage in activity on or about the property of The Missouri Caves and Karst Conservancy, Inc.  and its agent, Middle Mississippi Valley Grotto, Inc., does hereby and forever discharge The Missouri Caves and Karst Conservancy, Inc. and Middle Mississippi Valley Grotto, Inc., their agents, servants, officers, directors and employees from any and all claims, actions, causes of actions, demands, rights, damages, costs, loss of service, expenses, and compensation whatsoever, which the undersigned participants may have or which hereafter accrue on account or in any way growing out of any and all negligence, bodily and personal injuries and property damages and consequences thereof resulting or to result from any accident, casualty or event occurring in preparation for or during the course of the activity.


The undersigned further agrees to assume any risk that such activity may present and to indemnify and hold harmless The Missouri Caves and Karst Conservancy, Inc., Middle Mississippi Valley Grotto, Inc., and their agents for any and all liability for bodily and personal injuries and/or property damages suffered by the undersigned and resulting from such activity.


The undersigned further declares that no promise, inducement of agreement not herein expressed has been made to the undersigned, and that the undersigned fully understands this agreement, and that this release contains the entire agreement between the parties hereto, and that the terms of this release are contractual and not a mere recital.


    SIGNATURES                                           PRINTED NAMES

1._______________________________ ____________________________


2._______________________________ ____________________________


3._______________________________ ____________________________


4._______________________________ ____________________________


5._______________________________ ____________________________


6._______________________________ ____________________________


7._______________________________ ____________________________


8._______________________________ ____________________________


9._______________________________ ____________________________


10.______________________________ ____________________________


11.______________________________ ____________________________


12.______________________________ ____________________________


ALL PARTICPANTS MUST SIGN ABOVE BEFORE ENTERING THE CAVE. If you are less than 18 years of age you must have the signature of a parent or legal guardian. The recipient of this permit is responsible for the actions of everyone in his/her group and must return this form by mail within two weeks of the permit date even if no trip is taken. Your trip report is important to the management of Berome Moore Cave. Please try to be as accurate and complete as possible. Thank you.


     Permit #_______      Cave trip date:____/______/_______


     Trip Leader Name:_______________________________________________







                         TRIP REPORT

Entry Time:____________________                         Exit Time_________________________


Entry Date: ___________________                           Exit Date_________________________


Was the gate properly locked when you arrived?_______________________


Was there anything unusual about the cave condition? __________________




Where in the cave did your group go?



What was the purpose of your trip? Did you successfully complete that purpose?_______________________________________________________________________________

Did any member of you group suffer any injuries?________________________________________________________


Brief Comments: (Please advise if we are to expect a scientific report, survey information, or further correspondence regarding this trip.)







USE Additional Space if needed.