
| |
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. |
|

|
|