ENTRY
FORM -- Timucuan Challenge Paddle Race -
Date: ____________
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to benefit Climb for Cancer Foundation
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Presented by Performance MultiSports |
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Make check payable and
mail to:
Performance MultiSports - TC
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365 Charlemagne Circle |
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Ponte Vedra Beach, Florida 32082 |
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RACE
ENTRY FEES: Solo Kayak = $30
if postmarked more than three weeks before race; $40 until one week
before race; and $50 on race day. Tandem Kayak
or Canoe = $50 if postmarked more than three weeks before race; $70
until one
week before race; and $90 on race day.
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To enter, complete and mail in the entry form below:
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PRINT NAME
_____________________________________________________ ENTRY
AMOUNT ENCLOSED: _______ |
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First
Name
Last Name
Additional Donation to Climb for Cancer
Foundation $_______ |
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EMAIL
________________________________________________________________
AGE (on
race day) ______
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SEX: F M
SHIRT SIZE:
M L XL
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| CHECK
EVENT ENTERING (check one): Paddle Race/Short Marsh Course
q Paddle
Race/Ft George River Course |
Paddle Race/Full-length Marsh Course
q Non-race Tour
q
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| TYPE OF KAYAK OR CANOE: Touring or
Sea Kayak q Sit-on-Top Kayak q
Tandem Kayak q
Canoe q
Other
q
If "other" describe here:
_________________________________________________ |
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ADDRESS
________________________________________________________________________
APT. ____________
CITY _____________________________________________________ STATE
__________ ZIP ________________
PHONE/EVE ___________________
PHONE/DAY ____________________ BIRTH DATE: ____/____/____
EMERGENCY CONTACT ______________________________________
EMERGENCY PHONE ______________________
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WAIVER: In consideration of this entry, I, the
undersigned intending to be legally bound, hereby, for myself and anyone
acting on my behalf, release any and all claims for damages I may have
against the City of Jacksonville, National Park Service, Performance MultiSports,
Kayak Amelia, the Climb for Cancer Foundation and its
directors, officers, employees, and agents, the race directors,
volunteers, and any sponsors and their
representatives, successors and assigns for any and all injuries and death
suffered by me in said event. I attest and verify that I know that this competition can be a potentially hazardous activity. I have
sufficiently trained for the completion of this event and know that I am
participating at my own risk. I am also aware of the dangers of exercising
or competing in hot weather and humidity. I agree to abide by any decision
of a race official relative to my ability to safely complete the event. I
assume all risks associated with participating in this event, including,
but not limited to falls, contact with other participants, the effects of
the weather, traffic, and the conditions of the surface, all risks being
known and appreciated by me. I have read this waiver of liability and
accept the risks and responsibility associated with entering this event. I
hereby grant permission for the free use of my name and picture in any
broadcast, brochure, or account of this event.
Signature ____________________________________
Parent________________________________ Date __________
Tandem Partner ____________________________
Signature of Tandem Partner __________________________
If participant is under 18 years of age, parent or Guardian must sign.
A portion of proceeds from this event
benefit the Climb for Cancer Foundation |
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Return to Timucuan
Coastal Challenge |
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Return to Event Calendar |
