Registration Form and Waiver
January 5th through 8th, 2012
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) __________________
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 _________
If you are a sponsored team please indicate your sponsor
*______________________
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: Hunt 4 Hunger Inc.
P.O. Box 1065
Emporia, KS 66801 |
| _____-Competitive Division |
| _____-$50 " 10 canned goods |
| _____-$60 (no canned goods) |
| _____-Open Division |
| _____-10 canned goods |
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