Waiver of Registration Rights

							                                     Registration and Waiver Form
 Name                              Age             Address             Email Address              Phone Number




     Please indicate number and watercraft preference, based on a first come first serve basis.
             Watercraft               Credit Card Number           CC          CC ID            Cash
                                                               Exp. Date      Number
 ____Canoe(s) @$50 ea.

 ____Single Kayak(s) @$50 ea.

 ____Double Kayak(s) @$50 ea.

 ____Personal watercraft(s)@$50 ea.

                                                                                              Total

What you need to know!
All race participants must be pre-registered and paid in full (by credit card or cash only) prior to Thursday, September 16th.
Race day sign-in begins at 8:00am Saturday, September 19th at:

                                                  Gruff’s Tap & Grill
                                     19773 E Pennsylvania Ave.Dunnellon, FL 34432
                                                    (352) 465-2881

The 8 mile race shotgun is at 9:00am, with heats to be determined. All event rules will be strictly enforced. Participants must
be 18 years or older. No food or drinks allowed in disposable containers on the Rainbow River per County Ordinance 85-17,
94-4. If you can throw it away, don’t bring it! Volunteers will be at various locations along the river to refill beverage
thermoses and sport bottles. Snacks and beverages should be in Tupperware-type containers. Personal watercraft permitted
must be a canoe, single kayak, or double kayak. Donated kayaks, canoes and gear are limited; pre-registration is on a first
come first serve basis. First place prizes will be awarded in the single kayak category and double kayak category. Winners
will be announced at Gruff’s after the race so bring your chair and come relax for a day of fun!

As A participant in the Kayak for a Cause charity event, I, for heirs, administrators, and myself assume any and all risks
which might be associated with this event. I waive and release any and all rights and claims for damages which I may have
against the organizers and others connected with this event, their representatives, successors, and signs for any and all
injuries or damages of any kind whatsoever suffered by me as a resulted taking part in this event and related activities.

Participant Signature:___________________________________________Date:___________________

         Please forward your entry to: Fax: (352) 489-2288 or via email :mathew@boomtownmedia.net