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Paddle for Polen Registration
This fundraiser is dedicated to raising funds for The Allen and Joyce Polen Family Endowment for the Medically Underserved. Funds raised from this event will make it possible for those in our community who are in desperate need of specialty medical care to get the care they need. This fund greatly reduces the financial barrier to care that individuals and families often face.

Kayak and Canoe Race
Paddle for Polen is a family friendly event where you will be able to race, win prizes and have a great time out at the Winfield City Lake! There will be food trucks on site and we encourage you to bring the whole gang to watch and participate in the games. You will be able to use a canoe or kayak to race against people in your age group. Kayaks and Canoes are available for everyone. However, if you have your own, you are welcome to bring it with you. We will have several short distance races as well as a long distance race around the cove for all ages. We look forward to seeing you out there!
Winfield City Lake - 10:00 am until 2:00 pm - June 20, 2020
Registration begins at 9:00 am
Name (First and Last) *
Your answer
T-shirt Size (Please note that anyone registering AFTER April 30th is NOT guaranteed a t-shirt on event day, we will do an after event order): *
Address *
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
Phone *
Your answer
Age (Races will be held in age groups, this will help us better plan the event) *Ages 12 and under are welcome to participate at parent's discretion. Please note that any children under the age of 9 must ride in a canoe with an adult *
Your answer
Will you need a kayak or canoe? *
Emergency Contact Name (First and Last) *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone *
Your answer
Registration Fee of $25 must be paid in order to reserve your event t-shirt.
Checks can be made out to Legacy Regional Foundation (please note in the memo "Polen Fund") or cash can be dropped off at the Health Center, Arkansas City OR Winfield Chamber of Commerce.
ACKNOWLEDGEMENT OF RISK AND WAIVER
Waiver and Release Agreement & Participant Release of Liability and Assumption of Risk Agreement

-Please Read Carefully Before Signing-

In consideration of my participation and use of recreational areas (whether on land or in water) and the equipment provided by Arkansas River Coalition and Ark City Kayak Rentals, I, the undersigned, acknowledge, appreciate, and agree to the following release and waiver:

Scope of Release
This Release of Liability covers all activities indirectly or directly associated with the use of Arkansas River Coalition and Ark City Kayak Rentals equipment, facilities, services, and activities organized by, sponsored by, or directed by Arkansas River Coalition and Ark City Kayak Rentals.

Risk Factors
The undersigned understands and acknowledges that the Arkansas River Coalition and Ark City Kayak Rentals activities involve risks such as, but not limited to, the following: (i) changing water flow, conditions or current; (ii) collision with other participants, any portion of the interior of the craft, other water craft, man made or natural objects, including overhanging, submerged, and/or semi-submerged trees, branches, rocks, and/or boulders; (iii) cold weather and heat-related injuries and illnesses including hypothermia, frostbite, heat exhaustion, sun stroke, and/or dehydration; (iv) inclement weather, variances and extremes of wind, weather, and temperature, the presence of insects and animals; (v) sense of balance, physical coordination, ability to swim, and/or ability to follow directions; (vi) loss of control of the craft, collision, capsizing, and sinking of the craft which can result in wetness, injury, exposure to the elements, hypothermia, and drowning; (vii) Issues with getting in and out of the craft; (viii) travel, including hiking, portaging and travel to and from the related and unrelated activities; (ix) the presence of wild animals, including marine life forms, birds, and land animals; (x) unavailability of emergency aid services and emergency medical care; (xi) limited or no cell phone service due to remote locations.

The undersigned acknowledges that Arkansas River Coalition and Ark City Kayak Rentals activities, as well as other foreseeable or unforeseeable factors or circumstances, may result in a Risk of Property Damage, Bodily Injury, and Possibly Death.

Assumption of Risk
By executing this Release of Liability, the undersigned expressly assumes all risk that arise from the participation in Arkansas River Coalition and Ark City Kayak Rentals activities, the acts of others, the unavailability of emergency care, and any other foreseeable or unforeseeable factors or circumstances related to Arkansas River Coalition and Ark City Kayak Rentals activities. The undersigned assumes all risk of injury, wrongful death, or property damage related to the Arkansas River Coalition and Ark City Kayak Rentals activities.



Physical Conditions and Skills
The undersigned represents that he or she has the requisite skills (including but not limited to prior use of similar or the same equipment provided by Arkansas River Coalition and Ark City Kayak Rentals). Additionally, the undersigned represents that he or she has the physical and mental abilities necessary for proper and safe use and operation of the Arkansas River Coalition and Ark City Kayak Rentals equipment, facilities and services, and to be able to participate in the Arkansas River Coalition and Ark City Kayak Rentals activities. The undersigned agrees that he or she has been given ample opportunity to ask any questions or get any instruction he or she requires prior to beginning the activity.

State Laws
The undersigned agrees to abide by the Kansas Boating State Laws regarding extreme sports, paddling, hiking and camping. The undersigned agrees to on his or her behalf, or on behalf of a minor for which the undersigned is a parent or legal guardian, to wear a life jacket at all times while boating, floating, fishing, or other water related activities. The undersigned also agrees to abide by the equipment regulations set by manufacturers and Arkansas River Coalition and Ark City Kayak Rentals in addition to Kansas laws. Additionally, you are solely responsible for the safety and well-being of any and all pets you choose to include in your activity and Arkansas River Coalition and Ark City Kayak Rentals shall have no liability for any injury or death to an animal resulting from an animal participating in your activity.

UNDER KANSAS LAW, THERE IS NO LIABILITY FOR AN INJURY OR DEATH OF A PARTICIPANT IN A REGISTERED AGRITOURISM ACTIVITY CONDUCTED AT THIS REGISTERED AGRITOURISM LOCATION IF SUCH INJURY OR DEATH RESULTS FROM THE INHERENT RISKS OF SUCH AGRITOURISM ACTIVITY. RISKS OF SUCH AGRITOURISM ACTIVITIES INCLUDE, BUT SHALL NOT BE LIMITED TO, THE POTENTIAL OF YOU AS A PARTICIPANT TO ACT IN A NEGLIGENT MANNER THAT MAY CONTRIBUTE TO YOUR INJURY OR DEATH AND THE POTENTIAL OF ANOTHER PARTICIPANT TO ACT IN A NEGLIGENT MANNER THAT MAY CONTRIBUTE TO YOUR INJURY OR DEATH. YOU ARE ASSUMING THIE RISK OF PARTICIPATING IN THIS REGISTERED AGRITOURISM ACTIVITY.

Waive and Release
By attaching my signature hereto, I hereby knowingly and intentionally waive and release, indemnify and hold harmless Arkansas River Coalition and Ark City Kayak Rentals, their agents, employees and volunteers, on behalf of myself, my heirs, successors, executors and assigns from and against any and all claims, actions, causes of action, liabilities, suits, expenses (including reasonable attorney fees) which are related to, arise out of, or are in any way connected with my participation in these activities. That includes, but is not limited to, negligence of any kind or nature, whether foreseen or unforeseen, arising directly or indirectly from any activity, and any damage, loss, injury, paralysis, or death to me or damage or loss to my property as a result of my utilizing these services or equipment. Additionally, I agree to hold Arkansas River Coalition and Ark City Kayak Rentals, their agents, employees and/or volunteers, harmless from any and all liability related to these activities.

Property and Equipment Damage
The undersigned agrees to pay for any or all damages to property and equipment provided by Arkansas River Coalition and Ark City Kayak Rentals caused by the undersigned or any agent of undersigned.

Acknowledgement
The undersigned, parent or legal guardian of the participant has read and understands this Release of Liability and realizes it relates to surrendering valuable legal rights and assumes important legal responsibilities and does so freely and voluntarily. The undersigned, parent or legal guardian as a participant in the subject activity hereby consents to medical treatment in a medical emergency where the undersigned is unable to consent to such treatment.
E-Signature of Participant OR Parent of Guaridan is UNDER 18 years old *
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