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Performance Beach Kayak Races -- April/May 2005

Race #1 = Blues Fest Kayak Race - April 2, 2005 

Race #2 = Beach Kayak Race - April 30, 2005

Race #3 = Beach Kayak Race - May 14, 2005

RACE FEES (per Race):  Solo Kayak = $15 if postmarked two weeks before race day, $20 until day before race; $25 on race day.   Tandem Kayak or Canoe = $20 if postmarked two weeks before race day, $25 until day before race; $30 race day. 
  Make check payable and mail to: Performance MultiSports - Kayak Race # ___, 

365 Charlemagne Circle, Ponte Vedra Beach, FL 32082

 ENTRY FORM

PRINT PADDLER'S NAME ____________________________________________________________   AMOUNT ENCLOSED: ________

                                                  First Name                            Last Name                

EMAIL __________________________________________________   AGE (on race day) _____   SEX:   F   M     SHIRT SIZE:  M   L   XL

Name of Tandem Partner: ________________________________________________ Age: ____  Sex: F   M      Shirt Size:  M   L   XL

Tandem Partner's Email: _________________________________________________

CHECK EVENT(S) ENTERING (check one): Blues Fest Race- #1:q           Beach Race- #2:q    

                                                  Beach Race - #3:q                   Non-race Paddle q

TYPE OF KAYAK OR CANOE:    Touring  or Sea Kayak q      Sit-on-Top Kayak q     Tandem  Kayak q     Canoe q Surf-ski q

 

PADDLER'S ADDRESS ________________________________________________________________________ APT. ____________ 

CITY ____________________________________________________________ STATE __________ ZIP ___________________

PHONE/EVE ___________________   PHONE/DAY ____________________    BIRTH DATE: ____/____/____

EMERGENCY CONTACT __________________________________________ EMERGENCY PHONE _____________________________

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 Beach, Performance MultiSports, and their directors, officers, employees, and agents, the race directors 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 _____________

Name of Tandem Partner ______________________________ Signature of Tandem Partner ______________________________

                                                                   If participant is under 18 years of age, parent or Guardian must sign.

 

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