2015 USCA National Canoe & Kayak Championships Participant Registration Form

Transcription

1 Please Read Carefully 2015 USCA National Canoe & Kayak Championships Participant Registration Form To Pre-register by mail: Send the registration forms with personal check payable to WCCBI addressed to: WCCBI 308 Market Street, Warren, PA on or before August 1, For further information please go to or call WCCBI at Note: No day of race changes. Any changes to pre-registrations must be done by 5 p.m on the prior day and confirmed by registration personnel. Change forms will be located at Race HQ at Blair Distribution Center, Route 62 S. Irvine No day-of-event registration except for Orienteering, Biathlon and Youth Sprint events. All other events require pre-registration no later than 5 p.m. on the prior day USCA membership is required for all USCA championship and trial events. Send USCA membership application to: Membership Chair, Harold Theiss at Lake Jovita Blvd., Dade City, FL on or before July 25, 2015 or apply on site. Join on by August 1, Proof of membership is required for event registration. No day-of-event memberships taken except for Orienteering, Biathlon, and Youth sprints. Please plan accordingly. Registration Form Please fill out one form (all information) for each participant Print Legibly (Mail with Check or register on site a day in advance) Last Name (upper & lower not all caps) First Name (upper & lower) USCA Member # Official Use Only: Date Received: / /2015 Total Fees Form Date of Birth (mm/dd/yy) Home Phone Cell Phone Address City State Zip Country (Other than US) Fees Each Day: Day 1 Tuesday Day 2 Wednesday Day 3 Thursday Day 4 Friday Day 5 Saturday Day 6 Sunday Emergency contact Phone Relationship Total Fees $ Race Fees: Free t-shirt for marathon entrants preregistered by 8/1/15 Adult Marathon - $30 per paddler for first race. $5 for each additional race. Youth (5-14) Marathon - $5 per paddler for first race. $5 for each additional race. Junior (15-17) Marathon - $10 per paddler for first race. $5 for each additional race. Adult Sprints (Tuesday) - $20 per adult paddler for first race. $5 for each additional race. Registration due by 5 p.m. Monday,, August 10, Adult/Youth Sprints (Tuesday) - $5 per youth paddler. NO fee for adult participant Youth (5-17) Sprints (Thursday) - $5 per paddler for up to 5 events (A paddler may enter one each of C1, C2, C2 Mixed, K1 and SUP for a total of five (5) events). Sprint Championships for Paddlers with Physical Disabilities - $10 per adult paddler for first race. $5 for second race. Orienteering - $25 per adult participant. $5 per Youth (5-17) participant. Each participant must fill out the participant Registration Form above and submit it along with your registration form(s) for the different event(s) entered. On each registration form, please check the event(s) entered and fill in your name at the top with the amount of fees for the events entered. Transfer the fees for each page to the Total Fees Form above. An insurance waiver form must be signed by each participant at check in. Individual Safety Please refer to Safety Rules and Lightning Safety on page 1 in Important Information section. This is a must read for all. Registration Form PAGE 1 of 7

2 Adult & Adult/ Youth Sprints Tuesday, August 11, 2015 USCA National Canoe & Kayak Championships Adult Sprint and Adult/Youth Sprint Championships See Schedule of Events for start order. Adults may enter in one each category (C1,C2,C2Mx,K1,SUP) plus any or all adult/ (5-14) or adult/junior (15-17) events. A Youth may enter no more than one event and must be in their own age group. C1 Woman (18+) [C1 W] K1 Woman (18+) [K1 W] C1 Woman Master (40+) [C1 WMa] K1 Woman Master (40+) [K1 WMa] C1 Woman Senior (50+) [C1 WSr] K1 Woman Senior (50+) [K1 WSr] C1 Woman Veteran (60+) [C1 WV] K1 Woman Veteran (60+) [K1 WV] C1 Man (18+) [C1 M] K1 Man (18+) [K1 M] C1 Man Master (40+) [C1 MMa] K1 Man Master (40+) [K1 MMa] C1 Man Senior (50+) [C1 MSr] K1 Man Senior (50+) [K1 MSr] C1 Man Veteran (60+) [C1 MV] K1 Man Veteran (60+) [K1 MV] SUP Unlimited Woman [SUP-U W] SUP Unlimited Man [SUP-U M] C2 Women (18+) [C2 W] C2 Women Master (40+) C2 Women Senior (50+) C2 Women Veteran (60+) [C2 WMa] [C2 WSr] [C2 WV] C2 Men (18+) [C2 M] C2 Men Master (40+) C2 Men Senior (50+) C2 Men Veteran (60+) C2 Mixed (18+) C2 Mixed Master (40+) [C2 MMa] [C2 MSr] [C2 MV] [C2 Mx] [C2 MxMa] C2 W (18+)/Youth (5-7) [C2 W/Y (5-7) ] C2 W (18+)/Youth (8-10) [C2 W/Y (8-10)] C2 W (18+)/Youth (11-12) [C2 WY (11-12)] C2 W (18+)/Youth (13-14) [C2 W/Y (13-14)] C2 W (18+)/Junior (15-17) [C2 W/Jr (15-17)] C2 M (18+)/Youth (5-7) [C2 M/Y (5-7) ] C2 M (18+)/Youth (8-10) [C2 M/Y (8-10) C2 M (18+)/Youth (11-12) [C2 M/Y (11-12) C2 M (18+)/Youth (13-14) [C2 M/Y (13-14)] C2 M (18+)/Junior (15-17) [C2 M/Jr(15-18)] Pre-registration required by Monday 5 p.m. Ages <18 as of 1/1/ as of race day Minimum youth age is 5 Tuesday Sprint fees: Adult $20 per paddler + $5 per additional event Jr/Youth $5 per paddler Partner Age State Tuesday, August 11, 2015 USCA National Canoe & Kayak Championships Sprint Championships for Paddlers with Physical Disabilities Pre-registration required $10 for 1st race $5 for second K1* Paddler with Physical Disability Woman [PK1 W] V-1/OC-1** Paddler with Physical Disability Woman [PV1/OC1 K1* Paddler with Physical Disability Man [PK1 M] V-1/OC-1** Paddler with Physical Disability Man [PV1/OC1 M] * Any Kayak/surfski propelled with a kayak paddle (may have stabilizing floats and may have a rudder) ** Any Va a/outrigger Canoe propelled with a canoe paddle (may have stabilizing floats and may have a rudder) Registration Form PAGE 2 of 7

3 Orienteering Biathlon Wednesday, August 12, 2015 USCA National Canoe & Kayak Orienteering Championships Pre-registration requested, but not required. Beginners welcome! Adults (18+): $25/Paddler Jr/Youth (under 18): $5 C1 Woman [C1 W] K1 Woman [K1 W] SUP Unld W [SUP-U W] (SUP Demo Event) C1 Man [C1 M] K1 Man [K1 M] SUP Unld M [SUP-U M] (SUP Demo Event) (Any Kayak) Partner (Last Name & First Name) C2 Women [C2 W] C2 Men [C2 M] C2 Mixed [C2 Mx] C2 Mixed Master (40+) [C2 MxMa] C2 Woman/Youth (5-14) [C2 W/Y] C2 Man/Youth (5-14) [C2 M/Y] C2 Woman/Junior (15-17) [C2 W/Jr] C2 Man/Junior (15-17) [C2 M/Jr] State Wednesday, August 12, 2015 Philip H. Soule National Biathlon Championships USCA membership is not required for this event. No pre-registration. Day-of-race registration only. $15 per person This Biathlon is an unofficial fun event (welcomed by the USCA and the National hosts) managed by Tom Walton (Founder) with the assistance from Ray and Paula Thiel. Registration is on site at race HQ from 3:30 p.m. 4:30 p.m. Checks made out to Tom Walton. For more information at: twalton@nedelta.com or call ( ). This event combines the disciplines of running and paddling. One may compete solo (Iron) or with a teammate (Tin). The race begins with a 3K run, followed by a 3K paddle and finishes with a 30 meter dash (portage) to the finish line. Tentative start time is 5:00 PM. Course announced prior to the start of race. Banquet to follow at Holiday Inn of Warren.OPEN TO ALL USCA MEMBERS! Safety: This may be an unofficial event, but all USCA safety rules apply and waivers must be signed. Solo Events (Iron) Team Events (Tin) (You may use canoe, kayak or SUP on water) (Teams of two or more) There will be local recreational/cross country runners available to team up with, if you find running disgusting and gross. Iron Man or Woman/Boy or Girl Tin Men and Women/Boys and Girls 1. Youth Class: under Youth Class: under 18 Boys, Girls, Mixed 2. Open Class: Open Class: Men, Women, Mixed 3. Masters: Masters: Men, Women, Mix 4. Seniors: Seniors: 60+ Men, Women, Mixed Registration Form PAGE 3 of 7

4 Youth Sprints Thursday, August 13, 2015 USCA National Canoe & Kayak Youth Sprint Championships No Day-of-race registration permitted. A paddler may enter one each of C1, C2, C2 Mixed, K1, and SUP for a maximum of five ( 5 ) events. See Schedule of Events for the order of start Sprint Fee: $5 per paddler Maximum 5 events! 250 Meter Events C1 Youth (5-7) C1 Youth (8-10) Age on C1 Youth (11-12) Partner (Last Name - First Name) 1/1/15 State C2 Youth (5-7) C2 Youth (8-10) C2 Youth (11-12) K1 Youth (5-7) K1 Youth (8-10) K1 Youth (11-12) 500 Meter Events C1 Girl Youth (13-14) [C1 GY] A team s age is determined C1 Boy Youth (13-14) [C1 BY] by the older of the 2 C1 Woman Junior (15-17) [C1 WJr] paddlers in youth classes C1 Man Junior (15-17) (C1 MJr] K1 Woman Junior (15-17) [K1 WJr] K1 Man Junior (15-17) [K1 MJr] SUP Unlimited Man Junior [SUP-U MJr] SUP Unlimited Woman Junior [SUP-U WJr] Age on Partner (Last Name - First Name 1/1/15 State C2 Girls Youth (13-14) [C2 GY C2 Boys Youth (13-14) [C2 BY C2 Women Junior (15-17) [C2 WJr] C2 Men Junior (15-17) [C2 MJr] C2 Mixed Open (5-17) [C2 Mx] A Trial Marathon event for 5-12 year old youth will be held adjacent to the Sprint venue after the sprints and before the medal presentations. Medals will be awarded to the top three finishers in each age group for C-1 and K-1 classes. There will be one start. Distances for the different age groups may be adjusted to accommodate the time available and the participant s skill levels. Course may also be modified if weather dictates. Adults are encouraged to paddle along with competitors in a separate boat to provide safety coverage as well as encouragement to the competitors. C1 Youth (5-7) K1 Youth (5-7) C1 Youth (8-10) K1 Youth (8-10) C1 Youth (11-12) K1 Youth (11-12) Fee - $5 per paddler Registration Form PAGE 4 of 7

5 Marathon Day 1 Friday, August 14, 2015 USCA National Canoe & Kayak Marathon Championships Teams are determined by the age of the younger paddler. All adult ages are as of race day. Youth and Junior ages are as of January 1, Adult Fees: $30 for 1st event $5 for each additional event. Youth (5-14) Fees: $5 per race. Junior (15-17) Fees: $10 first race, $5 additional races K1 Unlimited Woman Open K1 Unlimited Woman Master (40+) K1 Unlimited Woman Senior (50+) K1 Unlimited Woman Veteran 1 (60+) K1 Unlimited Woman Veteran 2 (65+) K1 Unlimited Woman Grand Vet 1 (70+) [K1U W] [K1U WMa] [K1U WSr] [K1U WV1] [K1U WV2] [K1U WGV1] K1 Unlimited Woman Grand Vet 2 (75+) [K1U WGV2] K1 ICF Woman Open [K1 ICF W] K1 ICF Woman Master [K1 ICF Wma] K1 ICF Man Open [K1 ICF M] K1 ICF Man Master [K1 ICF MMa] C1 Woman Open [C1 W] C1 Woman Veteran 2 (65+) [C1 WV2] C1 Woman Master (40+) [C1 WMa] C1 Woman Grand Vet 1 (70+) [C1 WGV1] C1 Woman Senior (50+) [C1 WSr] C1 Woman Grand Vet 2 (75+) [C1 WGV2] C1 Woman Veteran 1 (60+) [C1 WV1] C1 Stock Woman Open [C1 SW] OC1 Man (OC1M) Partner Age State C2 Men Open [C2 M] C2 Men Master (40+) [C2 MMa] C2 Men Senior (50+) [C2 MSr] C2 Men Veteran 1 (60+) [C2 MV1] C2 Men Veteran 2 (65+) [C2 MV2] C2 Men Grand Vet 1 (70+) [C2 MGV1] C2 Men Grand Vet 2 (75+) [C2 MGV2] C2 Standard Men Open [C2 Std M] C2 Standard Men Master [C2 Std MMa] K2 Unlimited Men [K2 Unld M] Short Course Partner Age State C2 Men Junior (<18) [C2 MJr (<18)] C1 Woman Junior (<18) [C1 WJr] K1 Woman Junior (<18) [K1 WJr] Registration Form PAGE 5 of 7

6 Last Name (Upper & Lower not all caps) First Name (Upper & Lower not all caps Age Fees this page Carry to Total Fees form Page 1 Marathon Day 2 Saturday, August 15, 2015 USCA National Canoe & Kayak Marathon Championships Teams are determined by the age of the younger paddler. All adult ages are as of race day. Youth & Junior ages are as of January 1, Adult Fees: $30 for 1st event $5 for each additional event. Youth (5-14) Fees: $5 per race Junior (15-17) $10 first race, $5 additional races C1 Man Open [C1 M] C1 Man Veteran 2 (65+) [C1 MV2] C1 Man Master (40+) [C1 MMa] C1 Man Grand Vet 1 (70+) [C1 MGV1] C1 Man Senior (50+) [C1 MSr] C1 Man Grand Vet 2 (75+) [C1 MGV2] C1 Man Veteran 1 (60+) [C1 MV1] C1 Stock Man Open [C1 SM] OC1 Woman [OC1W] K1 Unlimited Man (18+) [K1UM] K1 Unlimited Man Master (40+) K1 Unlimited Man Veteran 1 (60+) K1 Unlimited Man Grand Vet 1 (70+) [K1UM Ma] K1 Unlimited Man Senior (50+) [K1UM V1] K1 Unlimited Man Veteran 2 (65+) [K1UM GV1] K1 Unlimited Man Grand Vet 2 (75+) [K1UM Sr] [K1UM V2] [K1UM GV2] Partner Age State C2 Standard Women Open [C2 Std W] C2 Standard Women Master [C2Std WMa] C2 Women Open [C2 W] C2 Women Master [C2 WMa] C2 Women Senior [C2 WSr] C2 Women Veteran 1[C2 WV1] C2 Women Veteran 2 [C2 WV2] C2 Women Grand Vet 1 [C2 WGV1] C2 Women Grand Vet 2 [C2 WGV2] K2 Unlimited Women [K2 UW] Short Course C2 Women Junior (<18) [C2 WJr] K1 Man Junior (<18) [K1 MJr] C1 Man Junior (<18) [C1 MJr] Registration Form PAGE 6 of 7

7 Marathon Day 3 Sunday, August 16, 2015 USCA National Canoe & Kayak Marathon Championships Teams are determined by the age of the younger paddler All adult ages are as of race day. Youth and Junior ages are as of January 1, Adult Fees: $30 for 1st event $5 for each additional event. Youth (5-14) Fees: $5 per event. Junior (15-17) $10 first race, $5 each additional race K1 Sea Kayak Woman [K1SeK W] K1 Sea Kayak Woman Master [K1 SeK Wma] K1 Sea Kayak Woman Senior [K1SeK WSr] K1 Sea Kayak Woman Veteran 1 [K1 SeK V1] K1 Sea Kayak Woman Veteran 2 [K1 SeK V2] K1 Sea Kayak Woman Grand Vet 1 [K1SeK GV1] K1 Sea Kayak Woman Grand Vet 2 [K1SeK GV2] K1 Sea Kayak Man [K1SeK M] K1 Sea Kayak Man Master [K1SeK MMa] K1 Sea Kayak Man Senior [K1SeK MSr] K1 Sea Kayak Man Veteran 1 [K1 SeK MV1] K1 Sea Kayak Man Veteran 2 [K1SeK MV2] K1 Sea Kayak Man Grand Vet 1 [K1SeK MGV1] K1 Sea Kayak Man Grand Vet 2 [K1SeK MGV2] Partner Age State C2 Standard Mixed (C2Std Mx) C2 Mixed Open (C2 Mx) C2 Mixed Master (C2 MxMa) C2 Man (18+) / Junior (C2 M/Jr) (15-17) C2 Woman (18+) / Junior (C2 W/Jr) (15-17) K2 Unlimited Mixed (TRIAL) (K2 U Mx) Short Course Events C2 Mixed Junior (C2 Mx Jr) (<18) C2 Man (18+) / Youth (C2 M/Y) (5-14) C2 Woman (18+) / Youth (C2 W/Y) (5-14) SUP Unlimited Woman [SUP U W] SUP Unlimited Man [SUP U M] Registration Form PAGE 7 of 7

8 United States Canoe Association Competition Cruising Conservation Camping Camaraderie AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY *****READ BEFORE SIGNING***** Name of Event: 2015 USCA National Championships Date(s) of Event: August 11-16, 2015 In consideration of being allowed to participate in any way in the UNITED STATES CANOE ASSOCIATION athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury from activities involved in this program is significant, including the potential for permanent paralysis and death; and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the UNITED STATES CANOE ASSOCIATION and WARREN COUNTY CHAMBER OF BUSINESS & INDUSTRY, CITY OF WARREN, BLAIR LLC and UNITED STATES ARMY CORPS. OF ENGINEERS their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event ( RELEASEES ), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I acknowledge that I am aware of the safety rules and regulations applicable to this event including the use of life jackets and lightning safety, and that I have read the USCA sanctioning guidelines and will attend the pre-event/prerace meeting. I also acknowledge that photographs and video may be taken of me in my participation in and attendance at this event, and hereby freely agree to allow without restriction all uses of such photos and videos in the reporting of this race, and/or in the promotion of this event, its location, other sporting events, sport in general, and/or related purposes. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. X DATE SIGNED: (Participant s Signature) X (Participant s Name and Address) **PLEASE PRINT** FOR PARTICPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above, of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. I further agree to the photographic and video releases set forth above. X (Parent/Guardian Signature) Date Signed (Emergency phone number)