1491592047379-mdhtwa9s7p-f3bc39757ef24a76b7b01186255c5eaf.jpg

Registration
Earth Day 2018

Let us know if you can make it!

Fill out the form below.

Please choose:

Note:

  • All JRBP canoes have been reserved for #EarthDay 2018.
 

 REGISTRATION FORM
 

*Age 18+ only, due to cold water temperatures & debri *When you bring your own boat, please bring your own life jackets
Primary Participant / Contact Person (Age: 18+) *
Primary Participant / Contact Person (Age: 18+)
By checking this box, I am verifying that I am my canoe's contact person and that I am age 18+. *
Phone of Primary Participant / Contact Person *
Phone of Primary Participant / Contact Person
#1 - Additional Participant
#1 - Additional Participant
*If you are registering for yourself only, please type in "NONE" *If floating, Age 18+ only, due to cold water temperatures & debris
*Float is age 18+ only, due to cold water temperatures & debris *No age requirement for shoreline clean-ups
#2 - Additional Participant
#2 - Additional Participant
*If you are registering for yourself only, please type in "NONE"
#3 - Additional Participant
#3 - Additional Participant
*If you are registering for yourself only, please type in "NONE"
EMERGENCY CONTACT (not attending float) *
EMERGENCY CONTACT (not attending float)
EMERGENCY CONTACT'S PHONE (not attending float) *
EMERGENCY CONTACT'S PHONE (not attending float)
I HAVE CAREFULLY COMPLETED THE FORM ABOVE and READ AND REVIEWED THE WIAVER RELEASE LIABILITY (AWRL) STATEMENT BELOW. *
ALL PARTICIPANTS READ CAREFULLY AND "DIGITALLY" SIGN ACKNOWLEDGEMENT WAIVER RELEASE LIABILITY (AWRL) FORM - below. I acknowledge that participating in Earth Day (Joe Kleiber Memorial) clean-up float event,(referred to as the “Event”) involves an above average risk of personal injury to me and my property, and I knowingly and voluntarily agree to the terms and conditions outlined in this CONSENT, WAIVER AND RELEASE FROM LIABILITY. In consideration and exchange for being permitted to participate in this event, I agree to the following: I am in good health and have no physical conditions that affect my ability to participate in the Event and have not been advised otherwise by a medical practitioner. I am responsible for all medical expenses that may occur due to the Event. I agree that before I participate in any portion of the Event, I will inspect the related facilities, site, and equipment. I will immediately advise Event personnel of any unsafe condition that I observe. I will refuse to participate in the Event until all unsafe conditions have been remedied. I will abide by any safety guidelines made available to me. I consent to the use and publication of my name and image in all forms of media while participating in the Event. I assume full responsibility for all risks associated with my participation in the Event and the risk of injury or damage caused by the condition of any property, facilities, or equipment used during the Event, which may not be foreseeable by anyone at any time. I hereby release, waive, discharge and agree not to sue the participants in the Event, James River Basin Partnership and other Event sponsors or organizers for any injuries, death, losses, damages, liabilities, or expenses that are caused or alleged to be caused by their negligent acts or omissions, or the condition of the property, facilities or equipment used for the Event. I agree to wear appropriate safety equipment, as may be established by industry or community standards and common safety practices, during the entire Event. In connection with any injury or other medical conditions I may experience during the Event, I authorize medical treatment deemed necessary by medical personnel if I am not able to act on my own behalf. I agree not to sue any applicable medical practitioners who are at the event who may provide medical treatment to me at the event for malpractice. This agreement shall be enforced and construed according to the laws of the state of Missouri. FOR PERSONS LESS THAN 18 YEARS OF AGE PARTICIPATING IN RIVER RESCUE, I VERIFY THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE PARTICIPANT AND I AGREE THAT THE FOREGOING AGREEMENT SHALL BE BINDING ON ME AND THE MINOR PARTICIPANT.