Nelson Downriver Race Registration Form

Please complete the form below, print it and mail it to
Nelson Downriver Race
Nelson Co. Parks and Recreation
8445 Thomas Nelson Hwy
Lovingston, VA 22949

OR you may bring the completed form when you register at the registration table at the put-in for the race.
OR you may email the completed form to roussos@lynchburg.edu

Fee: $20 per person
T-shirts may be purchased for $15 at the take-out.
For complete race information please see the website at nelsoncountyva.org/NelDRace
(Please consult with race officials to fill in the following information)
Boat Registration Classification ___________________
Race/Boat #: Fee Paid:

**** Begin Form Here ****

Boat Type: Canoe Kayak Sit-On-Top SUP Other

Your Information If Tandem, Enter Partner Information
Name: Name:
Gender: Male Female Gender: Male Female
Email: Email:
Addr. Addr.
City, State, Zip:
City, State, Zip:
Age: Age:
Phone: Phone:
Boating Experience:
Beginner Intermediate Advanced
Boating Experience:
Beginner Intermediate Advanced

Boat Make:

Boat Model:
My signature below certifies that I understand the risks of canoe/kayak racing and of negotiating rapids and other hazards. I voluntarily enter this race and of my own free will elect to paddle this course. In the event of my injury or death, neither I nor my heirs will hold responsible the race organizers, promoters, officals, Nelson County Parks and Recreation Department, the County of Nelson and all agents and employees of said Department and County. I further understand that I am responsible for all medical expenses and personal property damage that might be incurred as a result of my participation in the race.

Please do not attempt this race if you have doubts concerning your physical fitness, your ability to run rapids up to class III or your capability to rescue yourself should you have to swim. Helmets are strongly recommended as protection against head injury that may be caused by the obstacles in the river or above it. The wearing of a life vest is mandatory.

Signature: _________________________________________ Date: ______________

Partner Signature ____________________________________
If paddler is under 18 years of age Parent/Guardian signature is required above.