LETR BASS TOURNAMENT REGISTRATION

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Boater’s Full Name

Boater’s Cell Phone Number

Boater’s Street Address, City, State, ZIP Code

Boater’s Email Address

Boater’s Emergency Contact Name & Phone Number

Co-Angler’s Full Name

Co-Angler’s Cell Phone Number

Co-Angler’s Street Address, City, State, ZIP Code

Co-Angler’s Email Address

Co-Angler’s Emergency Contact Name & Phone Number

Boat Make, Model, & Color(s)

WAIVER OF LIABILITY

In consideration for being allowed to participate in the Law Enforcement Torch Run (LETR) Bass Tournament and receiving benefits therefrom, I do hereby, for myself, my heirs and representatives release LETR Bass Tournaments, the City of Warner Robins Georgia, the Warner Robins Police Department and all public officials, agents, employees or servants of the City of Warner Robins, which shall be referred to collectively as “the City,” from any and all liability , claims, demands, actions and causes of action of any nature whatsoever which I may hereafter have on account of any and all injuries, losses and or damages to me, including death, or to my property which arises out of or are related to my participation in LETR Bass Tournaments or any event or incident occurring while I am participating in LETR Bass Tournaments.

For the same consideration, I agree to forever hold LETR Bass Tournaments and the City harmless for any and all liability, claims, demands, actions or causes of action that may be asserted against LETR Bass Tournaments and the City for damages, losses, injuries, and expenses to include attorney fees resulting from any participation in the LETR Bass Tournament.

I expressly agree that this release and indemnity is intended to be as broad and inclusive as permitted by the laws of the State of Georgia and that if any portion hereof is held invalid the balance shall continue in full force and effect.

IF PARTICIPANT IS UNDER 18 YEARS OF AGE:

I, As parent/guardian do hereby certify that I have legal responsibility for the participant and I agree and give my consent to his/her release as provided above of all the releases, and, for myself, my heirs, assignees, and next of kin, I release and agree to indemnify and hold harmless the releases from any and all liabilities incident to my minor child’s, or ward’s, involvement or participation in the LETR Bass Tournaments as provided above, even if arising from the negligence of the releases, to the fullest extent permitted by law.

Electronic Signature Agreement *

By typing your name in the box below, you agree and acknowledge that 1) the document will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

Electronic Signature*

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