Accident Waiver And Release Of Liability Form

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ANNUAL KENDUSKEAG STREAM CANOE RACE
OFFICIAL ENTRY FORM
Sponsored by the Bangor Parks and Recreation Department
Race Date: Third Saturday in April
Race Start Time: 8:30 A.M.
RACE DAY CHECK-IN and/or
Boat Make: _________________
Pre-Registration Cost - $25.00 pp
REGISTRATION
Day of Race Cost - $50.00 pp
Boat Model: _________________
6:30 – 7:45AM SHARP
Pre-registration accepted until 1:00pm,
Friday before the race
Boat Length: ________________
@
Kenduskeag Village
Participants in the same boat
Pre-registrants must check in and pick-up
Briefing at 8:00 A.M.
materials between 6:30 – 7:30am
must be on this form!!!
PLEASE PRINT CLEARLY
Name ____________________________________________
Name ____________________________________________
Birth Date __________ / _________ / ____________
Birth Date __________ / _________ / ____________
Mailing Address ___________________________________
Mailing Address ___________________________________
City & State ______________________________________
City & State ______________________________________
Zip Code ______________________
Zip Code ______________________
Telephone Number ________________________________
Telephone Number ________________________________
Email____________________________________________
Email____________________________________________
Name ____________________________________________
Name ____________________________________________
Birth Date __________ / _________ / ____________
Birth Date __________ / _________ / ____________
Mailing Address ___________________________________
Mailing Address ___________________________________
City & State ______________________________________
City & State ______________________________________
Zip Code ______________________
Zip Code ______________________
Telephone Number ________________________________
Telephone Number ________________________________
Email____________________________________________
Email____________________________________________
Please return all 3 pages to Bangor Parks and Recreation
Reminder: You are not registered unless paid in full

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