RELEASE:

I realize that every time that I leave shore in a small boat, I am a potential drowning victim. In addition, there is the possibility of injury from many things, including unseen obstacles, weather, currents, waves, insects and other boaters. Human powered water craft require physical effort which can at times be heavy, including: lifting, pulling and possibly prolonged exertion in adverse conditions. We are not responsible for providing water and provisions along the route. This event includes 3 dams to portage! I may have to ride in vehicles other than my own and with drivers I may not know. In signing this release, I indicate my understanding of the risks involved with activities involving human powered water craft, and agree to take full responsibility for my physical condition, actions, and safety.

NOW THEREFORE, INTENDING TO BE LEGALLY BOUND, I DO HEREBY WAIVE, for myself, my heirs and assigns and for anyone else whomsoever claiming through me, my right to sue or in any other way to attempt to hold responsible, VKM, its officers, any so called “trip leaders” or “event coordinators”, or any of my fellow paddlers, for any mishaps to my person or my equipment, other than that which is due to the willful and malicious action of the individual against whom I claim relief.

SIGNATURE: _________________________________________________________DATE: ___________________

(Signature of Parent or Adult Guardian for persons under 18 years of age)

Name: ___________________________________________________________Home Phone:____________________

Address:_________________________________________________________________________________________

City:State:Zip:____________________________________________________________________________________

EMAIL ADDRESS:_______________________________________________________________________________

Entry Fee $10.00 per person. Amount Enclosed: _________________________________Tandem:_____ Solo:____

If paddling tandem, please list partner’s name:________________________________________________________

What is the make/model, color, and # (if applicable) of the boat that you will be paddling?

_________________________________________________________________________________________________

Please mail form to: Hugh Heward Challenge, P.O. Box 533, Portland, MI 48875 

Make check payable to: VERLEN KRUGER MEMORIAL