Adirondack Watershed Alliance
(518) 891-2744
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* THIS FORM CAN NOT BE USED FOR THE ADIRONDACK CANOE CLASSIC - "90 MILER"

TUPPER LAKE 9 MILER

Adirondack Watershed Alliance

PO Box 66 Lake Clear, NY 12945           (518) – 891 – 2744

Canoe and Kayak Event Application

Paddler 1:                                                                                        Paddler 2:

Name:  ___________________________________                              Name:  ___________________________________

Address:  _________________________________                               Address: _________________________________

              _________________________________                                             _________________________________

Home phone: ______________________ Age: ____                                Home phone:  _______________  Age:  _____

Email Address :_____________________________                                Email Address:  __________________________

PLEASE CIRCLE YOUR AGE CATEGORY                    UNDER 50                  50 PLUS

PLEASE CIRCLE YOUR GENDER CATEGORY            MALE             FEMALE         MIXED

ARE YOU A MEMBER OF AWA?   YES  NO ~~ ARE YOU A MEMBER OF NYMCRA?  YES   NO

PLEASE CIRCLE YOUR RACING CATEGORY:

1 PERSON GUIDEBOAT                   2 PERSON GUIDEBOAT                               OPEN TOURING

SOLO RECREATION            C- 2 RECREATION               C-2 FAMILY

 

TOURING KAYAK               UNLIMITED KAYAK            2 PERSON KAYAK

C-1 STOCK                C-2 STOCK                C-4 STOCK                                        VOYAGEUR

 

C-1 AMATEUR          C-2 AMATEUR

 

See Adirondack Race Series Canoe and Kayak Classes, General Rules and Specifications for definitions.

 

Participant Release

I agree that there is an inherent danger in the sport of canoe and kayak racing.  By my signature below I am stating that I am in appropriate physical condition to participate and accept all risks and consequences of my actions.  I agree to hold harmless the organizers, sponsors, land owners, municipalities and any other person or entity involved in the event liable 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 to be used for educational and promotional purposes related to paddle sports and the Adirondack Watershed Alliance.  Furthermore, I release any and all royalties thereto.

Paddler 1 Signature ________________________________________     Paddler 2 Signature ______________________________________

Parent Signature __________________________________________      Parent Signature _________________________________________

(Required if entrant is under 18 years old)

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