Nelson Downriver Race Registration Form (submit in person at race)

Fee: $20 per person ($30 with T-Shirt). Add $5.00 for a second race (see info. on early morning race). Price includes picnic after race. Paddlers are encouraged to bring a veggie dish or dessert where practicable. $5.00 fee for those who wish to picnic only.
For complete race information please see the website at nelsoncountyva.org/NelDRace

Please fill in the information below.

Race/Boat #:	Fee Paid:
Boat Type: (Circle One) Canoe, Kayak, Sit-On-Top, Other
Boat Make:	Boat Model:
Your Information	If Tandem Enter Partner Information
Name:	Name:
Gender: Male Female	Gender: Male Female
Email:	Email:
Addr.	Addr.
City, State, Zip:	City, State, Zip:
Age:	Age:
Phone:	Phone:
Boating Experience: Beginner Intermediate Advanced	Boating Experience: Beginner Intermediate Advanced

My signature below certifies that I understand the risks of canoe/kayak racing and of negotiating rapids and other hazards. I voluntarily enter this race and of my own free will elect to paddle this course. In the event of my injury or death, neither I nor my heirs will hold responsible the race organizers, promoters, officals, Nelson County Parks and Recreation Department, the County of Nelson and all agents and employees of said Department and County. I further understand that I am responsible for all medical expenses and personal property damage that might be incurred as a result of my participation in the race.

Please do not attempt this race if you have doubts concerning your physical fitness, your ability to run rapids up to class III or your capability to rescue yourself should you have to swim. Helmets are strongly recommended as protection against head injury that may be caused by the obstacles in the river or above it. The wearing of a life vest is mandatory.

Signature: _________________________________________ Date: ______________

Partner Signature ____________________________________
If paddler is under 18 years of age Parent/Guardian signature is required above.

Boat Registration Classification ___________________ (Please consult with race officials)