1. No category

41st Annual
Connecticut River
Raft Race
July 25, 2015
Captain’s Name _________________________________ Email Address _________________________________________
Address _________________________________________ Town _________________ State ____________ Zip ___________
Phone @ Home ___________________________Cell __________________________ Work __________________________
Name of Vessel ___________________________ Size ___________________________Number of Crew Members______
Flotation _________________________________________________________________________________________________
(i.e., barrels, foam, wood, metal, fiberglass, other)
Propulsion________________________________________________________________________________________________
(i.e., poles, oars, paddlewheels, propeller, sail, combo, other)
Please  check box below to indicate your racing category
 C – Sweeper Raft
 A - America Raft
 C - Cruising Raft
 SK – Single Kayak
 MK - Multiple Kayak
 SC - Single Canoe
 MC - Multiple Canoe
Class Prefix______________ Number of Your Choice _________________
Race Entries Must
Display Their
Registration Number
Entry Fee Paid ________________________Special Award Class ______________________________________________
($16.00 per crewmember)
Date___________ Captain’s Signature_________________________ Notary ____________________________
THIS FORM MUST BE NOTARIZED
Participants may pre-register for the 41st Annual Connecticut River Raft Race by submitting a
notarized entry form; hold harmless agreement signed by all crew members, and submit all
registration fees prior to the Captains meeting on July 11th, 2015. Mail your entry forms to:
Dan “Otto” Pritchard, 8 Hale Road, Portland, Connecticut 06480
2015 Entry Forms – Revision 1, 04/08/15
RELEASE & HOLD HARMLESS FORM
Each Captain and their crew members must sign this release and hold
harmless agreement. Each captain agrees to be individually responsible for
the actions and welfare of their crew and their water craft. The captain
represents that all crew members have been trained and warned in the
hazards of water craft and rafting. Each person signing this agreement,
participating in the 41st Annual Connecticut River Raft Race, fully
recognizes and assumes all risks and hazards involved in such an activity.
Neither officers nor directors of Connecticut River Raft Race Inc. (CRRR)
nor Portland Riverside Marina have any duty to nor have any control over
the actions of the undersigned, either on the water or on land. Each signer,
hereby agrees that they have no rights or claims against CRRR, it’s officers
and directors, as well as Portland Marina and that each of the undersigned,
agree to take responsibility and control of themselves and any person invited
by the signer to this event and hold CRRR and Portland Marina harmless for
any injuries to such persons or caused by such persons.
Captain’s Name (please print) _______________________________________________________________________
Captain’s Signature________________________________________________________________Date____________
Please List All Crew Members Aboard Your Entry
Designated Driver
Check for Yes
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Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
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Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
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Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
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Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
Print Name_______________________________Signature_____________________________Date____________ 
Use extra sheet to list additional crew
2015 Entry Forms – Revision 1, 04/08/15