Name / Crew

Address City/Town Postal Code

Telephone (Home) Telephone (Cell / Other)

Email Address Birthday: M D Y

_ _ / _ _ / _ _ _ _CIRCLE SIZE (UNISEX)

Emergency Contact Info

Name: _________________ Relationship to Paddler: ________________

Telephone: ____________________________

Add Shirt($10)

Pickering Rouge Canoe Club is proud to announce the return of the PRCC PaddleSport Challenge on Saturday, June 14th, 2014! This event combines all

disciplines of paddling into one rock show of a regatta. 2013 was a big success and we hope to grow the event even bigger this year!!! Below are the disciplines that are offered as well as registration information. We look forward

to seeing you on the water!

S

M

L

XL

Registration$10

Registration$25

Registration$110

Registration$25

Registration$50

Registration$400

Registration Fee for SUP, Outrigger, and Surfski paddlers includes a T-Shirt.

Other participants can buy shirts at event or add $10 to registration fee

Mailing Information:PRCC91 Rylander Blvd, Unit 7, Box 187Scarborough, Ontario, M1B 5M5

Or forms can be emailed to darrenmossman8@gmail.com as well as e-transfer payments

2014

Registration$25

WAIVER FORM

In consideration of acceptance, I for myself and on behalf of my child and for my heirs, executors, administrators, successors and assigns hereby release, waive and forever discharge the Pickering Rouge Canoe Club (hereinafter called “PRCC”), its directors, club officials, volunteers, members, organizers, employees, coaches, sponsors, and administrators (hereinafter called the “Release”) of and from all claims, liabilities, demands, damage costs, expenses, actions, and causes of actions, whether in law or in equity, of every kind of nature whatsoever, in respect of death, injury, loss or damage to any person property, howsoever caused including but not limited to the negligence of any of the Releases, arising out of or in any way related to or connected with my or my child’s participation in practices, competitions, or any other activities of the PRCC, including use of boats or other equipment from PRCC, or any travel incidental thereto.

I warrant that I/my child am/is physically and mentally fit to participate in the practices, competitions, or any other activities using equipment from PRCC and that I/my child is an able swimmer. I understand that paddle sports are a dangerous activity that exposes participants to many hazards and risks, which I accept as a condition of my/my child’s use of equipment or facilities from PRCC.

I hereby acknowledge having read, understood and agree to accept the terms and conditions of this Release. ____________________________________ ____________________________________*Applicant’s/Parent’s Signature Date

* Parent or guardian to sign on behalf of child if child is under the age of 18 years.

Details regarding parking, boat transportation, etc., can be found on our website at www.pickeringrougecc.org

-or-You can send questions to our event email at

PRCCpaddlesport@gmail.com

@PRcanoeclub