2004 BCE Feeder Open and Junior Olympic Qualifier
Race Registration Application
May 30, 2004
First Name: ____________________
Last Name: ____________________
Street Address: ____________________
City: ____________________
State: ____________________
Zip Code: ____________________
Date of Birth: ____________________
USACK No. ____________________
Age Groups:
Cadet (14 and younger): _____
Junior (15 to 18): _____
Open (19 and up): _____
Senior (over 30): _____
Master (over 40): _____
Class:
C-1 _____
K-1 _____
K-1W _____
C-2 _____
C-2 Partner:
Race Registration Fee:
$30 for first class and $5 for each additional class
Mail Registration Application, BCE Waiver and check by May 22 to:
2004 Feeder Open & JO Qualifier
P.O. Box 54
Cabin John, MD 20818
Registration on Saturday May 29 from 12-2 PM at the Brookmont Church is $35
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WAIVER, RELEASE AND INDEMNITY
The undersigned applicant (and, if the applicant is a minor, the undersigned parent or legal guardian of the applicant) hereby releases and discharges and further agrees to indemnify and hold harmless, the BCE, its directors, officers, employees and agents, and each of their successors and assigns from any and all claims for damage or loss to the applicant, the BCE or any other person or entity which may arise out of or result from the applicant’s participation in any BCE program or activity. This waiver, release and indemnity is given with full understanding that such programs and activities, including, but not limited to, whitewater paddling and the maintenance of whitewater paddling facilities, are dangerous and involve risk of sudden injury, including risk of permanent disability and death, and may involve risks not known or reasonably foreseeable at this time.
Note: Minors are less than 18 years of age at time of application.
Parent or guardian must sign under Signature of Applicant.
_______________________________ ____________ ________________________
Signature of Applicant Date Relationship to Minors
_______________________________ ____________
Signature of Second Applicant Date
_______________________________ _________________________________
Name of minor applicant Name of minor applicant
_______________________________ ________________________________
Name of minor applicant Name of minor applicant
