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 INDICATE YOUR AGE CATEGORY UNDER 50 50 PLUS

PLEASE INDICATE 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)