American Canoe Association WWOC Slalom Nationals
1999 ACA WWOC Slalom Nationals Entry Form
_____________________________________ Sex: ____ Date of Birth:
Address: _____________________________________________ ACA# _________________
City: ________________________ State: __________________ Zip: ___________________
Phone: ______________________ e-mail: _________________________________________
Pre-registration (postmarked by June 21) $25 per person (for one race class); each additional class is $10. Late Registration fee $10. If you are not an ACA member, add $5 for event membership to cover insurance. One Race T-shirt is included per entry packet ($10 for each additional T-shirt). Additional $7 for BarBQ dinner ticket for Saturday's Race Dinner..
In the lists below, mark the classes you wish to enter (maximum 5 classes).
Competitors may race in both REC and RAC classes, but not for the same class.
|Saturday July 10 - Slalom||Sunday July 11 - Slalom|
|Class||RAC||REC||Partner's Name||Class||RAC||REC||Partner's Name|
|OC-2 Cadet/Senior||____||n/a||________________||OC-2 Premier||____||____||________________|
|OC-2 Mixed||____||____||________________||OC-2 Masters||____||____||________________|
|OC-2 Junior||____||n/a||________________||OC-1 Premier Short||____||n/a|
|OC-1 Master||n/a||____||OC-1 Junior||____||n/a|
|OC-1 Premier||n/a||____||OC-1 Masters Short||____||n/a|
|OC-2 Women||____||n/a||________________||OC-1 Women||____||____|
|OC-1 Master Med||____||n/a||OC-1 Premier Med.||____||n/a|
( the Slalom portion of the
Combined event will be held Sat and Sun, the race order decided
Monday July 11 Combined (Downriver Sprint portion of the Combined event)
|Class||RAC||REC||Partner's Name||Make checks payable to:|
|OC-1 Women||____||____||Rocky Mt. Canoe Club-Nationals|
|OC-2 Mixed||____||____||_____________________________||Send payment & completed forms to:|
|OC-1 Premier||____||____||Jill Stecker, '99 Nationals|
|OC-2 Premier||____||____||_____________________________||279 Forrest Lane|
|Basic registration fee ($25)||$ ________||Boulder, CO. 80302|
|No. of additional classes you will enter____x $10||$ ________|
|ACA event membership ($5)||$ ________|
|Late registration fee ($10 if after Jun 21th)||$ ________|
|No. of $7 tickets for the BBQ ____.||$ ________|
|No. of extra T-shirts ($10) S___M___L___XL___.||$ ________||Total amount enclosed $________|
|Your T-Shirt Size _______|
WAIVER & RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the American Canoe Association, Inc. athletic/sports programs and related events and activities, the undersigned:
1. Agree that prior to participating, they each will inspect the facilities and equipment to be used, and if they believe anything is unsafe, they will immediately advise their coach or supervisor of such condition(s) and refuse to participate.
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severs social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.
3. Assume all the foregoing risks and accept personal responsibility for damages following such injury, permanent disability or death.
4. Release, waive, discharge and covenant not to sue American Canoe Association, Inc., its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releasees," from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or part by the negligence of the releasees or otherwise.
THE UNDERSIGNED HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY.
|signature of participant||ACA memb. #||date of signing||date of birth|
|printed name of participant||address, city, state, zip|
club or organization:___________________________________________________________
When the participant is a MINOR (under 18 yrs.): Age of participant:_______
|signature of parent or guardian||printed name of parent or guardian||relationship|
Be sure to complete and return both forms
For additional entry
information phone Bob or Jill Stecker (303) 444-3979, 8am-6pm
or email email@example.com
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