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Hunting Entry Form
| Hunt 4 Hunger | Emporia, KS 66801 | 620-343-0225 | E-mail Us Page updated on 02/25/10 Site Maintained by Tonya Carson |
Registration Form and Waiver
December (date to be announced), 2010
HUNTER #1 INFORMATION:
Name_______________________________________________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
Home Phone ______________________________
Email_______________________________________
PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only):
Last Name_______________________________ First
Name___________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
HUNTER #2 INFORMATION:
Name_______________________________________________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
Home Phone ______________________________
Email_______________________________________
PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only):
Last Name_______________________________ First
Name___________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
By signing below the participant (or parent/guardian) acknowledges the following:
1) All participants represent that they are physically and mentally competent and fit and able to
participate. By entering, all participants agree to assume all risks of personal injury, death, and
damage to or loss of property and further agree to indemnify and hold Hunt 4 Hunger, its
organizers, and sponsors harmless from and against any and all claims, liabilities, and causes of
action resulting directly or indirectly from participation.
2) Acknowledges and fully understands that he or she will be engaging in activities that involve
risk of serious injury, including permanent disability and death, not only from his/her own
actions, inactions, and negligence of others and condition of the equipment used. Furthermore,
there may be risks not reasonably foreseeable at the time.
3)Furthermore, the participant acknowledges that they have read and understand the benefit
rules and agrees to abide by all local , state, and federal fishing and boating laws and
regulations while participating in the tournament. The participant also acknowledges that they
may be photographed during the benefit, and they consent to the use of those photographs for
the promotion of the benefit and Hunt 4 Hunger.
The undersigned has read the above waiver and release and understands that he/she has
given up substantial rights by signing it and does so voluntarily.
Signed______________________________________________________________
Date________________________
Signed______________________________________________________________
Date________________________
Make checks payable to:
Hunt 4 Hunger
A $35 fee will be charged for all returned checks.
Please send this completed entry form and fee to:
Hunt 4 Hunger
Attn: Chuck Gardner
1102 Union St
Emporia, KS 66801
December (date to be announced), 2010
HUNTER #1 INFORMATION:
Name_______________________________________________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
Home Phone ______________________________
Email_______________________________________
PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only):
Last Name_______________________________ First
Name___________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
HUNTER #2 INFORMATION:
Name_______________________________________________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
Home Phone ______________________________
Email_______________________________________
PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only):
Last Name_______________________________ First
Name___________________________________
Address_____________________________________________________________________
City __________________________ State____________________
Zip_________________________
By signing below the participant (or parent/guardian) acknowledges the following:
1) All participants represent that they are physically and mentally competent and fit and able to
participate. By entering, all participants agree to assume all risks of personal injury, death, and
damage to or loss of property and further agree to indemnify and hold Hunt 4 Hunger, its
organizers, and sponsors harmless from and against any and all claims, liabilities, and causes of
action resulting directly or indirectly from participation.
2) Acknowledges and fully understands that he or she will be engaging in activities that involve
risk of serious injury, including permanent disability and death, not only from his/her own
actions, inactions, and negligence of others and condition of the equipment used. Furthermore,
there may be risks not reasonably foreseeable at the time.
3)Furthermore, the participant acknowledges that they have read and understand the benefit
rules and agrees to abide by all local , state, and federal fishing and boating laws and
regulations while participating in the tournament. The participant also acknowledges that they
may be photographed during the benefit, and they consent to the use of those photographs for
the promotion of the benefit and Hunt 4 Hunger.
The undersigned has read the above waiver and release and understands that he/she has
given up substantial rights by signing it and does so voluntarily.
Signed______________________________________________________________
Date________________________
Signed______________________________________________________________
Date________________________
Make checks payable to:
Hunt 4 Hunger
A $35 fee will be charged for all returned checks.
Please send this completed entry form and fee to:
Hunt 4 Hunger
Attn: Chuck Gardner
1102 Union St
Emporia, KS 66801
