Philippians 4:13 Ministry, Inc.

1^st Annual Paddle for People 2008

Trent River, Jones County, NC

September 27, 2008

Please complete and print return this application along with a signed copy of the Release and Waiver Form and  registration fee prior to September 12, 2008:

Philippians 4:13 Ministry, Inc.

1^st Annual Paddle for People

P.O. Box 348

Pollocksville, NC  28573

252-671-9711

Registration details:

• Registration fee is $20.00 per person.  This fee includes an event hat, boxed lunch and beverage.
• You will be able to pick up your paddle information and hat on the morning of the paddle at the launch site.
• All participants will need to be at the launch site no later than 8:30 am on September 27, 2008.
• This event is rain or shine.
• Children under the age of 18 must be accompanied by a parent or guardian.
• EACH REGISTERED PARTICIPANT MUST READ AND SIGN THE RELEASE AND WAIVER FORM.
• Each person must wear a Type III U.S. Coast Guard approved personal floatation devise.

Individual Registration is $20.00 per person.

Name: __________________________________________________________

Address:  ________________________________________________________

City: ____________________________ State: ________ Zip: ______________

Email address: ____________________________________________________

Phone number: ___________________________________________________

Member of:_______________________________ Paddling Association or Club.

___ Beginner    ___ Intermediate   ___ Advanced         ___ Canoe    ___ Kayak

Under the age of 18: _____ yes ____ no / Over the age of 18:  ___ yes ___ no

Philippians 4:13 Ministry, Inc.

1^st Annual Paddle for People 2008

Trent River, Jones County, NC

September 27, 2008

Please complete and return this Release and Waiver Form with your application and registration fee prior to September 12, 2008.

Philippians 4:13 Ministry, Inc.

1^st Annual Paddle for People

P.O. Box 348

Pollocksville, NC  28573

RELEASE AND WAIVER FORM

Canoeing and Kayaking (paddling) can be physically demanding and/or dangerous.  Canoeist and Kayakers (paddlers) take responsibility for their personal safety and the safety of their crew and equipment. 

The undersigned participant (“Participant”) acknowledges that there are certain risks of damage to equipment and personal injury and injury to persons involved in the activities in which the Participant is applying to participate in.  Participant agrees to assume all risk of such damage and injury to Participant and anyone in Participant’s vessel at any time during the event.  Participant releases and agrees to hold harmless all organizers, sponsors, directors and officers of  Philippians 4:13 Ministry, Inc. from and against any and all claims, damages, injuries, suits and actions arising out of Participant’s participation in the event.

If you have any questions regarding your safety or paddling ability please send your questions to:  Philippians 4:13 Ministry, Inc., @ P.O. Box 348, Pollocksville, and NC 28573.  Your questions will be addressed prior to the event.

__________________________________           ________________________

    Signature                                                                          Date