Raisin River Canoe Race – Registration Form Please Print Clearly so that you will show up properly in the results! Participant 1 Full Name: Age: Male Female Gender: High School (if applicable): Email: Phone: Street Address: City: Postal Code: Participant 2 (if in the same boat) Full Name: Age: Male Female Gender: High School (if applicable): Email: Phone: Street Address: City: Postal Code: Category Kayaks Single, Over 14 feet long Single, 14 feet and under Single, Student Canoes 12 13 14 (18 or younger) Double Kayak 15 Student Canoes Pro Boats 17 Foot Open Men’s Recreational Women’s Recreational Mixed Recreational 1 2 3 4 Both participants 18 or younger Student Men Student Women Student Mixed 9 10 11 5 (1 Man, 1 Woman) Adult and Youth 6 (1 Adult, 1 Youth) Race Day Price is $20.00 per participant. Students (18 or younger) are $15.00. For office use: Amount Received For office use: Canoe Number Please Read and Sign the Waiver on the back! . Raisin River Canoe Race Waiver and Photo Release I, the undersigned, hereby acknowledge, appreciate and agree that the risk of injury from the activity of canoeing or kayaking in the Raisin River Canoe Race is significant including the potential for permanent paralyses and death. I knowingly and freely assume all such risks both known and unknown and assume full responsibility for my participation in the race. I represent that I understand the nature of the activity and that I am qualified and am in good health and in proper physical condition to participate in the activity which involves travel on or being in extremely cold water, white water rapids, eddies, whirlpools and dams. I agree to participate wearing the proper safety equipment required. I realize that there may be other Risks not known to me or not readily foreseeable, but I fully accept and assume all such risks whether or not identified above and I assume all responsibility for losses and damages which I may suffer as a result of my participation in the Raisin River Canoe Race. PLEASE NOTE: First Responders and Fire Department Assistance will be providing Shore Based Rescue only where available. First responders are not to enter the water. Please follow their instructions if required. I understand that I may be photographed or videotaped during the event, and the Raisin Region Conservation Authority may use those photographs or video footage for its marketing purposes. I, for myself and on behalf of my heirs, assigns, executors, estate trustees, personal representatives and next-of-kin hereby release, indemnify and hold harmless the Raisin Region Conservation Authority, its officers, officials, directors, staff, volunteers, agents used to conduct the Raisin River Canoe Race from any and all claims, demands, losses and liabilities arising from the negligence of the releases to the fullest extent permitted by law. I have read the foregoing Release, Assumption of Risk and Indemnity Agreement fully. I understand its terms, understand that I have given up substantial rights and signed it freely and voluntarily without inducement. Participant 1 Signature (18 or older) Participant 2 Signature ( 18 or older) Signature of Participant 1 Guardian (if participant is younger than 18) Signature of Participant 2 Guardian (if participant is younger than 18) Date Date
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