Firecracker Race Registration Step 1 of 4 0% NameThis field is for validation purposes and should be left unchanged.Contact DetailsName(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code AMERICAN CANOE ASSOCIATION WAIVER & RELEASE OF LIABILITY READ BEFORE SIGNING IN CONSIDERATION of being permitted to participate in any way in the American Canoe Association, Inc. sports and recreation program and related activities (“Activities”) I, for myself, my personal representatives, assigns, heirs, and next of kin: 1.ACKNOWLEDGE, agree, and represent that I understand the nature of paddlesports and related activities and that I am qualified, in good health, in proper physical condition to participate in such activity and willingly agree to comply with the stated and customary terms and conditions of participation. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. If I decide to leave early and not complete the trip as planned, I assume all risks inherent in my decision to leave. 2.FULLY UNDERSTAND that: (a) Paddlesports and related ACTIVITIES INVOLVE RISKS AND DANGERS OF DAMAGE TO PERSONAL PROPERTY AND SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (“RISKS”);(b)these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE “RELEASEES”NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS,AND DAMAGES I incur as a result of my participation or that of the minor in the Activity. 3.HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the American Canoe Association, Inc., its Paddle America Clubs, affiliated clubs and organizational affiliates, their respective ACA certified instructors, certified instructor trainers, and certified instructor trainer educators, administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS,LOSSES, INJURIES, DAMAGE TO PROPERTY, OR OTHER DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE,AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.Signature(Required) Event DetailsGender(Required)MaleFemaleNon-binaryAgenderMy gender isn't listedPrefer Not to AnswerThis field is hidden when viewing the formAge16-2425-3435-4445-5455-6465+Birthday(Required) MM slash DD slash YYYY Would you like a race t-shirt?(Required)Racers can chose a race t-shirt or reserve a dinner at the after race award ceremony. YES, I want a race t-shirt NO, reserve me an after race dinner instead Class & Payment DetailsAre you an ACA Member?(Required) Yes, ACA Member Non ACA Member What is your ACA Number?(Required)Select your Race Class(Required) K1 Mens Sea Kayak K1 Womens Sea Kayak K2 Mens Sea Kayak K2 Womens Sea Kayak K2 Mixed Sea Kayak K1 Mens Open Kayak K1 Womens Open Kayak K2 Mens Open Kayak K2 Womens Open Kayak K2 Mixed Open Kayak C1 Mens Canoe C1 Womens Canoe C2 Mens Canoe C2 Womens Canoe C2 Mixed Canoe SUP Mens – Stand Up Paddle Board SUP Womens – Stand Up Paddle Board Voyager Class – 3 or more Name of Paddling PartnerName of Voyager Team Leader?Will you be using our shuttle bus for an additional $5?(Required) Yes No Picks you up in Alton (FINISH) at 8:00 and takes you to Grafton (START). Drop off your boat and gear in Grafton and then leave your vehicle in Alton.Total Credit Card Cardholder Name Card Details Δ