Hugh Heward Challenge Registration, April 24th, 2010
Please mail to: P.O. Box 533, Portland, MI 48875
Make check payable: VERLEN KRUGER MEMORIAL
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: _______
ü Please
select your Hugh: ___Whole/Dimondale ___Half/Grand Ledge
___Quarter/Charlotte Hwy Bridge
Name: ___________________________________________________________
Phone:____________________
Address:__________________City:_______________State:____Zip:_________
EMAIL (optional):_______________________________________________
Entry Fee $10.00 per person. Amount Enclosed: _________________________________Tandem:_____
Solo:____
If paddling tandem, please list partner’s name:___________________________________________________________
What is the make/model, color, of the boat that you will be paddling?________________________________________
New
this year- Camping and shuttle service available this year please indicate your plans:
ü
Camping at
Lions Park in Dimondale: ____Yes ____No
____Maybe
Shuttle service interest: ____Yes _____No
____Maybe
