* THIS FORM CAN NOT BE USED FOR THE ADIRONDACK CANOE CLASSIC - "90 MILER"
'ROUND THE MOUNTAIN
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.
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)