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