Name
First
*
Last
Gender
Male
Female
Address
Street Address
*
Address Line 2
City
State / Province / Region
ZIP/Postal Code
Age
Phone (Home or Cell)
Emergency Contact Name
First
Last
Emergency Contact's Phone
Enter Email
example@example.com
Conrm Email
example@example.com
Kayak Club Member?
If you are a member of a kayak club, please enter the club name here.
How did you hear about Paddle Punta Gorda?
TEAM Punta Gorda E-Mail/Website
Family or Friend
Club Newsletter/Website
Kayak Shop
Poster/Flyer
Social Media
Newspaper/Radio/TV
Other
The T-shirts are unisex sizing. Please select from the following choices.
Medium
Large
X-Large
Please select the paddling venue you most prefer, your First Choice.
*
Alligator Creek (SITE FULL, PLEASE PICK ANOTHER LOCATION)
Peace River from Lettuce lake
Peace River at Nav-A-Gator (Kayak Rental Available Here)
Ponce de Leon Park (Kayak Rental Available Here) (SITE FULL, PLEASE PICK, ANOTHER LOCATION)
Shell Creek
Wm R. Gains Veterans Memorial Park
Babcock Webb
Please select your SECOND CHOICE in case your first choice is not available at the time you register.
Peace River from Lettuce Lake
Peace River at Nav-A-Gator (Kayak Rental Available Here)
Ponce de Leon Park (Kayak Rental Available Here) (SITE FULL, PLEASE PICK ANOTHER LOCATION)
Shell Creek
Wm R. Gaines Veterans Memorial Park
Babcock Webb
Please select your THIRD choice in case your first and second choices are not available at the time you register.
Alligator Creek (SITE FULL, PLEASE PICK ANOTHER LOCATION)
Peace River from Lettuce Lake
Peace River at Nav-A-Gator (Kayak Rental Available Here)
Ponce de Leon Park (Kayak Rental Available Here) (SITE FULL, PLEASE PICK ANOTHER LOCATION)
Shell Creek
Wm R. Gaines Veterans Memorial Park
Babcock Webb
Agree to Release
RELEASE OF ORGANIZERS AND SPONSORS: The undersigned hereby releases Team Punta Gorda, members, volunteers, ocers, directors, and event leaders from any and all causes of action, claims, damages, personal injury, and forever waives the right to sue for any alleged negligence. The undersigned assumes the risk involved in paddling, recognizes that paddling is a hazardous activity, agrees to wear a PFD at all times, follow all applicable boating laws and event rules, and recognizes that paddling may involve hazards, including, but not limited to, strenuous physical activity and interaction with boats on waterways. Other rules apply
*
(Type Your Name Here)
I agree to the above release
If you need to rent a kayak, be sure to pick one of the two venues that will have rentals available. Those venues are Peace River at Nav-A-Gator and Ponce de Leon Park. Kayak rentals are $25 (in addition to the $25 registration fee).
Yes, I need to rent a Kayak
No, I don't need a rental.
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Date of Submission of this Form
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