Name__________________________  Phone #______________________

Address______________________________________________________

City________________________________ State______ Zip____________

Email ______________________________

Affiliation__________________________________________ (school / club)

Event #______ Event Abr._______ Age on race day______ Freshmen (Y/N) ___

Lightweight (Y/N)______ Predicted 1000m/2000m/6000m score ____________

Send completed entry form and $15 fee to:

PIRC c/o PACJC
P.O. Box 669
Redwood City, CA 94064

Make checks payable to Peninsula Aquatic Center Junior Crew.

Legal Waiver
In consideration of acceptance of this entry in said regatta, I the undersigned participant, intending to be legally bound, do hereby for myself, my heirs, executors, and administrators, waive, release, and forever discharge any and all rights and claims for damages which may hereafter accrue to me against any and all persons, organizations, and legal entities affiliated with such regatta, more particularly, Stanford Rowing Center, Peninsula Aquatic Center Junior Crew and Burlingame High School, together with their respective officers, agents, employees, successors, assigns, and/or sponsors; for any and all damages which may be sustained or suffered by me in connection with, or entry in, and/or arising out of our traveling to or participating in, and not withstanding & 1542 of the California Civil Code.