Registration Form and Waiver
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January 6th through 9th, 2011HUNTER #1 INFORMATION: Name ____________________________________________ Address __________________________________________ City ___________________ State ___ Zip _________ Home Phone ___________ Email____________________ PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only): Last Name_________________ (First) __________________ 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) __________________ Address_______________________________________________ City ___________________ State ___ Zip _________ By signing below the participant (or parent/guardian) acknowledges the following:
- 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.
- 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.
- 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 |
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