...Print this out, fill it out, and send it in
- don't forget the release form!...
Please Print.
1. Name_________________________________________
Address_________________________________________
City ___________________ State _____ Zip________
Phone ______________________________ Age________
2. Name_________________________________________
Address_________________________________________
City ___________________ State _____ Zip________
Phone ______________________________ Age________
3. Name_________________________________________
Address_________________________________________
City ___________________ State _____ Zip________
Phone ______________________________ Age________
4. Name_________________________________________
Address_________________________________________
City ___________________ State _____ Zip________
Phone ______________________________ Age________
Children under 12 must be accompanied by parent or legal guardian.
Fill out, enclose Registration Fee of $50, mail BEFORE May 1.
Add $5 per person after May 1.
Which trip? 9:00 AM_____10:00 AM_____1:00 PM_____ 2:00 PM______
Fundraising goal $ _______________
( ) Send me More brochures 5 10
20 50 _____
( ) I'm unable to paddle,
but please accept my check for $ _________
( ) My company has a matching gifts program
Mail registration form and check made payable to :
Canoeing for Kids
114 Riverchase Court
Lexington,
SC, 29072
Release Form
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