Name:___________________________________________________ Age: _____________

Address:_______________________________________________________________________

City: _________________________________________State: _______ Zip:_____________

Phone # (       )_____________________

Release of Liability / Photo Release

As parent or guardian of above named child, I hereby certify that said child has my permission to attend and participate in the above mentioned Kid's Fishing Derby. In signing this form, I hereby waive and release all other participants, Hosts, Sponsors and all other Officials or Parties involved in the Derby from all clanms and/or damage incurred in connection with this Fishing Derby. I also hereby grant the Sponsors and Co-Sponsors the unconditional right to use the name, voice and photographic likeness of the child in connection with any of their audio/video productions, articles, or press releases, but not as an endorsement.

___________________________________________
Signature of Parent or Legal Guardian

___________________________________
Signature of Child

The deadline for mail-in registration is July 28, 2008. All mailed entries must report to the sign-up table prior to fishing in order to receive a number for registering their fish and receive their welcome bag. If they do not show prior to fishing, the fish will not count. Registration will also be at the Event in person. Saturday August 2nd, 2008 (all day). Sunday August 3rd, 2008 (8:00am to 9:00am). No exceptions, please.