Adirondack Watershed Alliance
(518) 891-2744
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ADIRONDACK CHALLENGE FLATWATER CANOE RACE           SUNDAY JULY 21, 2013 

Pre registration required by July 15, 2013
Make checks payable to: Adirondack Watershed Alliance - mail completed form to:  PO Box 66 Lake Clear, NY 12945 

Paddler 1:                                                                   Paddler 2:
Name: __________________________________             Name: _____________________________________

Address: ________________________________             Address: ___________________________________

________________________________________             ___________________________________________

Home phone: ___________________Age: ____              Home phone: _______________ Age: ___________

Email Address: ____________________________           Email Address: ______________________________
ARE YOU A MEMBER OF AWA? YES             NO               ARE YOU A MEMBER OF AWA? YES                         NO

Paddler 3:                                                                 Paddler 4:
Name: __________________________________           Name: _____________________________________

Address: _________________________________          Address: ___________________________________

_________________________________________            ___________________________________________


Home phone: ___________________Age: _____           Home phone: _______________ Age: __________

Email Address: _____________________________       Email Address: ______________________________
ARE YOU A MEMBER OF AWA? YES             NO             ARE YOU A MEMBER OF AWA? YES             NO

 

C-4 Pro-Class Teams please indicate category:

MIXED             MEN                 WOMEN           SENIOR

Amateur Teams please indicate class and category: _______________                 _________________

 Participant Waiver and Release

I acknowledge and agree that there are inherent dangers in the sport of canoe and kayak racing. As evidenced by my signature below I represent and agree that I am in appropriate physical condition to participate and accept all risks and consequences of my participation. I agree to hold harmless the organizers, sponsors, land owners, municipalities, New York State, the New York State Urban Development Corporation, d/b/a Empire State Development, the New York State Department of Economic Development and any other person or entity involved in the event against any liability for any injury incurred by me and/or my minor child while participating in this activity. I further give my permission for my name and photograph (and the name and photograph of my minor child) to be used for educational and promotional purposes related to paddle sports, the Adirondack Watershed Alliance and promotion of tourism and water sports in New York State. Furthermore, I release any and all royalties, copyright and any other rights (including but not limited to any privacy rights under Article 5 of the Civil Rights Law.)

Paddler 1 Signature ____________________________          Paddler 2 Signature___________________________
Parent Signature ________________________________         Parent Signature______________________________



Paddler 3 Signature ____________________________          Paddler 4 Signature___________________________
Parent Signature ________________________________         Parent Signature_______________________________

(Parent signature required if entrant is under 18 years old)

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