NOTE: Tournament is limited to 200 Junior Anglers FAX Number 904-824-8324

Angler 1:  Name:   Age:   Birthdate:
Angler 2:  Name:   Age:   Birthdate:
Angler 3:  Name:   Age:   Birthdate:

Contact Phone:

Waiver: (Please read carefully before signing.)
As the parent and/or Captain of the vessel of the above named participant(s), this is to acknowledge that I realize that my child is
participating in the Junior Kingfish Challenge at his or her own risk. I confirm that we have read and fully understand the rules of
the Tournament and this waiver and agree to abide by the rules and terms of this waiver. I agree that in consideration for the
acceptance of this entry and of my child's participation in the Junior Kingfish Challenge Tournament, for my child and myself,
I hereby release and forever discharge Ancient City Game Fish Association, Inc. (ACGFA) d/b/a Kingfish Challenge Tournament,
it's sponsors, it's representatives, successors and assigns of all liabilities, claims, actions, damages, costs or expenses which I or
my child may have against them arising out of or in any way connected with my child's participation in this event. I understand
that this waiver includes any claims based in negligence, action or inaction of any of the above-named parties. I hereby authorize
the use of my child's name and or likeness as well as that of all crew members, free of any consideration, for promotion and
advertising purposes in any media form and reproduction, including, but not limited to radio, television, newspaper, brochure,
video, or Internet.