Official Entry Form - Loyalsock Slalom - 8 April 2001

RELEASE: I certify I have read the ACA rules and the rules of the race and will abide by them. I certify that I am an amateur paddler by ACA definition. I certify I am an able swimmer. By submitting this entry form I agree to release, indemnify, and hold harmless the PSOC Whitewater Club, the Wildwater Boating Club, each of the officers and members of the club, their agents, and all others involved in the sponsorship of this race, from and aggainst all claims, suits, costs, expenses (including legal fees), and damages of any kind by reason of injury, death, or damage to property arising out of my participation in this race. I understand fully the dangers and hazards that exist in whitewater paddling over rocky and fast-moving streams where upsets and cold environmental conditions are common. 
Signed: ____________________________________ (Competitor) Date: _______________

Parent or guardian of a competitor not yet 18 years of age must sign below indicating he/she understands that whitewater racing is dangerous, and agrees to conditions in the above release statement, and encourages his/her child to enter. 

Signed: ____________________________________ (Parent or Guardian) Date: _______

*** Please also sign the ACA Release Form or ACA Release Form for Minors *** 

Competitor (print) ______________________________________ Birthdate: __________

Address: ________________________________________________ Club: _______________

City & State: _______________________________________________ Zip _________

ACA No: _______________ USCKT No: ______________  Telephone: _____-_____-______

Please read the Info sheet before marking your classes!!!

Open Canoes: OC-1, OC-1 Medium, OC-1W, OC-2, OC-2W, OC-2M.
Decked Boats: K-1, K-1W, C-1, C-1W, C-2, C-2W, C-2M, K-1R, K-1S.
Indicate JUNIOR or MASTERS (if applicable). 

1. $12.00 / person. Class: ______ Partner: ___________________ USCKT Rank _____

2.  $8.00 / person. Class: ______ Partner: ___________________ USCKT Rank _____

ADDITIONAL $5.00 / person late fee for entries postmarked later than 28 March 2001.

Total amount of fees enclosed: $_________

Send this form with a check made payable to PSOC to:

Lee DeWolski
Loyalsock Slalom Registrar
RD 1 Box 184
Port Matilda, PA 16870

For use by registrar; please do not write below this line.