2017 Vermilion Race Registration
Now you can register and pay on-line.

Pay $13 per person with your credit card or bank account, by using Paypal service, if you wish to race twice pay a total of $19 per person and indicate in the note your second race class and partner's name, if any.
Keel-Hauler club members get a $2 discount. Join Our Club Today

Registration:  Please fill out all the information on the form below.

Do not pay until you fill out and submit the registration.       Pay with PayPal - it's fast, free and secure!

After you "Submit Registration" you will be shown a copy of your submittal. Check it over to ensure that it is correct.

Hit "Return to the Form" at the bottom of submittal form.   
You will get a blank form, then click on "Click to Pay" box on the right. >>>>>>>>

Or just sign into your Paypal account and send your payment to rodeo@keelhauler.org

If you submitted your registration but decide to pay by check, there is no need to fill out another application, we will receive a copy of your submittal
Just mail your check with your Name & Class to:
Keel Haulers Canoe Club
Sam Reynolds - Treasurer
1174 Karla Dr
Clinton, OH 44216

Please fill out all applicable information

USCA Race Waiver 

I have read, understand, and accept the terms of the Waiver below
  ==> CLICK and Read the Waiver Below!!!

No, I do not accept, cancel my Registration      

Print / Read and Sign a USCA Waiver then bring it with you to race registration
I am a 2017 Keel -Hauler member - Members get a $2.00 discount. 
Last Name        Age     
First Name
Address
City
State
Zipcode & Zip+4 -  
Home Phone
E-mail
Applicable for Classes 1 - 5 only  
My partner is a 2017 Keel-Hauler member - Members get a $2.00 discount.
Partner Last Name        Age     
Partner First Name
Partner Address
Partner City
Partner State
Partner Zipcode & Zip+4 -  
Partner Home Phone
Partner E-mail
Race Classes - Read Rules for Details Check the Class that you are registering for
1 - C-2 Unrestricted   8 - K-1 Short <11.5’, Men 
2 - C-2 Mixed or Women   9 - K-1 Short <11.5’, Women 
3 - C-2 Men’s Standard 10 - K-1 <14.5’, Men   
4 - C-2 Senior > 49 yrs 11 - K-1 >11.5’, Women 
5 - C-2 Over & Under 12 - K-1 <14.5', Senior > 49 yrs
6 - C-1 One Person Canoe 13 - K-1 Long >14.5’, Men
7 - K-1 Junior < 16 yrs 14 - K-1 Long >14.5’, Senior > 49 yrs
15 - K-1 Woman >11.5’, Senior > 49 yrs
16 - SUP - Men or Women
Note or Question for Race Chairman
When Form is complete hit - 
Submit Registration 		It will return to a blank form

Then click on the "Click to Pay Box" on top right.

                 or                  

AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY
READ BEFORE SIGNING

Print a copy of Waiver, and bring to race

Event Name: Vermilion River Race   Date: - March 26, 2017 or backup date April 2, 2017

In consideration of being allowed to participate in any way in the UNITED STATES CANOE ASSOCIATION athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or other and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the UNITED STATES CANOE ASSOCIATION, Inc, and Keel Haulers Canoe Club their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

_____________________________    _________________________ Date: ______

(Participant Name – Please Print)                           (Participant’s Signature)

_________________________________________________   Participant Address

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above, of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

X________________________  _________________________________    ______

(Parent/Guardian Signature)              (Emergency phone number)                      Date

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Web Author:  John Kobak
Copyright © 2008...2017 Keel Haulers Canoe Club.  All rights reserved.
Revised: January 20, 2017 .